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THE  PATHOLOGY  OF  MIND. 


THE 


PATHOLOGY  OF  MIND. 


BEING   TEE  THIRD  EDITION  OF  THE  SECOND  PART  OF 

THE  ''PHYSIOLOGY  AND  PATHOLOGY  OF  MIND;' 

RECAST,   ENLARGED,   AND  REWRITTEN. 


BY 

HENRY  MAUDSLEY,   M.  D. 


NEW   YOEK: 
D.    APPLETON    AI^D    COMPANY, 

1880. 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/pathologyofmindbOOmaud 


PEEPACE. 

The  first  edition  of  the  Physiology  and  Pathology  of  Mind  was 
published  in  the  year  1867,  and  the  second  edition  in  the 
year  following.  A  third  edition  of  the  first  part  was  published 
in  the  year  1876  as  a  separate  treatise  on  the  Physiology  of 
Mind.  In  the  order  of  time  and  development  this  volume  on 
the  Pathology  of  Mind  is  therefore  a  third  edition  of  the  second 
part;  but  in  substance  it  is  a  new  work,  having  been  recast 
throughout,  largely  added  to,  and  almost  entirely  rewritten. 

The  new  material  which  has  been  added  includes  chapters  on 
"  Dreaming  "  and  on  "  Somnambu.lism  and  its  Allied  States," 
subjects  which,  although  they  may  not  perhaps  be  thought  to 
appertain  strictly  to  a  treatise  on  mental  pathology,  will  be 
found,  when  studied  scientifically,  to  throw  light  upon  its 
obscure  phenomena  and  to  help  to  bridge  the  gap  between  it 
and  mental  physiology.  A  perplexing  impression  was  produced 
on  my  mind  when  I  first  began  to  study  mental  diseases — now 
upwards  of  twenty  years  ago — by  the  isolation  in  which  they 
seemed  to  be.  On  the  one  hand,  treatises  on  psychology  made 
no  mention  of  them,  and  gave  not  the  least  help  towards  an 
understanding  of  them  ;  and,  on  the  other  hand,  treatises  on 
mental  disorders,  while  giving  full  information  concerning 
them,  treated  their  subject  as  if  it  belonged  to  a  science  en- 
tirely distinct  from  that  which  was  concerned  with  the  sound 
mind.      Inasmuch   as  psychological,  physiological,  and  patho- 


vi  PEEFACE. 

logical  studies  of  mind  were  actually  concerned  with  the  sane 
subject-matter,  it  was  obvious  that  methods  of  study  which 
kept  the  different  lines  of  inquiry  entirely  apart  must  be  at 
fault  somewhere,  and  that  it  would  be  a  right  aim,  and  one 
full  of  promise,  to  endeavour  to  bring  them  into  relation  with 
one  another,  and  so  to  make  psychology,  physiology,  and 
pathology  throw  light  upon  and  give  help  to  one  another. 
The  first  edition,  as  stated  in  its  preface,  was  the  firstfruits 
of  that  endeavour,  and  the  present  volume,  which  embodies 
the  results  of  deeper  studies  and  more  ripened  experience,  is 
tlie  completion  of  it.  The  inclusion  in  it  of  chapters  on  the 
abnormal  mental  phenomena  which  are  exhibited  in  dreams, 
hypnotism,  ecstasy,  catalepsy,  and  like  states,  is  therefore  a  just 
part  of  the  fulfilment  of  the  general  design. 

The  same  reason  will,  I  trust,  be  held  sufficient  to  justify 
the  large  amount  of  new  and  in  some  regards  disputable  matter 
which  is  included  in  the  chapters  on  the  "  Causation  and  Pre- 
vention of  Insanity."  It  seemed  proper  to  emphasise  the  fact 
that  insanity  is  really  a  social  phenomenon,  and  to  insist  that 
it  cannot  be  investigated  satisfactorily  and  apprehended  rightly 
except  it  be  studied  from  a  social  point  of  view.  In  that  way 
only,  I  believe,  can  its  real  nature  and  meaning  as  an  aberrant 
phenomenon  be  perceived  and  understood.  In  recasting  the 
plan  of  the  work  I  have  thought  it  right  therefore,  in  the 
chapter  on  Causation,  first  to  treat  generally  of  the  etiology  of 
mental  derangement  from  a  social  standpoint,  so  fulfilling  the 
requirements  of  its  organic  relations,  so  to  speak,  in  the  social 
organism ;  and,  secondly,  to  treat  particularly  of  its  patho- 
logical causation,  so  connecting  it  with  the  general  pathology 
of  nervous  disease,  and  answering  the  requirements  of  scientific 
pathology. 

In  describing  the  symptoms  of  insanity,  I  have  thought  it 
well  again,  first,  to  treat  it  generally  as  one  disease,  setting 
forth  the  varieties  of  symptoms  which  it  presents  at  different 


PEEFACE. 


Vll 


times  and  at  different  stages  of  its  course;  and,  secondly,  to 
occupy  a  separate  chapter  witli  the  delineation  of  the  different 
clinical  groups  of  mental  disorders  which  are  met  with  in  practice 
and  have  to  be  dealt  with  by  the  physician.  In  this  way  I 
hope  to  have  met  the  obligations  of  a  true  scientific  exposition 
and  the  more  practical  needs  of  those  who  have  to  form  an 
opinion  concerning  the  cause,  the  course,  the  probable  termina- 
tion, and  the  proper  treatment  of  a  particular  case  of  disease. 
Had  the  chapter  on  Symptomatology  been  left  out,  the  omis- 
sion must  needs  have  entailed  a  great  deal  of  vague  repetition 
in  the  description  of  the  cKnical  groups,  with  the  certain  effect 
of  blurring  their  outlines  and  features,  and  of  confusing  the 
reader;  had  the  special  chapter  describing  these  groups  been 
omitted,  he  would  have  obtained  only  a  vague  and  general 
notion  of  the  symptoms  of  mental  derangement,  without  that 
more  definite  and  practical  acquaintance  with  its  clinical 
varieties,  which,  now  that  we  are  able,  I  think,  to  delineate 
their  features,  ought  to  form  part  of  a  treatise  on  mental  dis- 
orders. Whatever  be  the  value  of  the  chnical  pictures  in  this 
volume,  they  have  certainly  been  drawn  from  life,  and  had 
space  permitted  I  might  have  illustrated  each  line  of  description 
by  the  records  of  cases. 

The  full  and  analytical  Index  which  has  been  added  will 
serve  not  only  to  make  reference  easy,  bat  will  enable  the 
reader  to  judge  what  sort  of  fare  he  may  expect  if  he  is 
minded  to  make  trial  of  it. 


CONTENTS. 


CHAPTER  I. 

PAGE 

SLEEP   AND   DREAMING   .      , 1 


CHAPTER   II. 
HYPNOTISM,   SOMNAMBULISM,    AND   ALLIED   STATES 50 

-4    CHAPTER  III. 

THE    CAUSATION    AND    PREVENTION    OF    INSANITY 83 

(a)   ETIOLOGICAL. 

-:^'   CHAPTER  IV. 

THE    CAUSATION   AND    PREVENTION   OF   INSANITY 127 

(a)  ETIOLOGICAL  [continued), 

-^    CHAPTER  V. 
the  causation  and  prevention  of  insanity 175 

(b)  pathological. 


THE    INSANITY   OF   EARLY   LIFE 


CHAPTER  VI. 

256 


X  CONTENTS. 


CHAPTER  VII. 

PACE 

THE   SYMPTOMATOLOGY   OF   INSANITY 296 


CHAPTER  VIII. 

THE   SYMPTOMATOLOGY   OF   INSANITY   (continued) 356 

CHAPTER  IX. 

CLINICAL  GROUPS   OF   MENTAL    DISEASE 432 

CHAPTER  X. 

THE  MORBID  ANATOMY  OF  MENTAL  DERANGEMENT.   ,,,,..   489 

CHAPTER  XI. 

THE   TREATMENT   OF    MENTAL   DISORDERS 522 


PATHOLOGY  OF  MIND. 

CHAPTEE  L 

SLEEP  AND  DREAMIXG. 

As  we  pass  nearly  the  third  part  of  our  short  lives  in  sleej)  it  is 
pleasing  to  think  that  the  time  so  spent  is  not  misspent  nor  lost. 
Sleep  marks  that  periodical  suspension  of  the  functions  of  animal 
life,  or  life  of  relation,  during  which  the  organs  that  minister  to 
them  undergo  the  restoration  of  energy  which  is  necessary  after 
a  period  of  activity.  Waste  of  substance,  which  is  the  con- 
dition and  the  result  of  active  exercise  of  function,  must  bo 
repaired  during  rest ;  instead  of  its  being  a  surprise,  therefore, 
that  we  sleep,  the  wonder  would  be  if  we  did  not  sleep.  In  the 
work  and  thought  of  the  day  is  given  out  by  degrees  the  energy 
which  has  been  stored  up  during  repose.  The  need  of  repair  is 
as  true  of  the  organic  functions,  which  never  seem  to  sleep,  as  it 
is  of  the  animal  functions,  which  sleep  through  so  large  a  pro- 
portion of  our  lives.  For  although  an  organ  like  the  heart  seems 
not  to  rest  day  or  night  from  the  first  moment  of  action  unto  the 
last  moment  when  it  ceases  to  beat  more,  yet  it  plainly  rests 
bv^tween  each  stroke,  gaining  thereby  in  alternating  snatches  of 
repose  the  energy  for  the  next  stroke ;  and  it  is  really  at  rest 
during  a  longer  period  than  it  is  in  action — has  rested  more  than 
it  has  worked  when  its  life-work  is  ended.  If  the  heart  of  an 
animal  wliich  is  beating  regularly  when  the  chest  is  opened  be 
made  to  beat  slowly  by  stimulation  of  its  vagus  nerve  it  will  go 
on  beating  for  a  long  time ;  but  if  its  beats  are  quickened  by 


2  PATHOLOGY  OF  MIND.  [chap. 

irritation  of  its  sympathetic  nerve  it  soon  comes  to  a  standstill 
from  exhaustion ;  nutritive  repair  and  the  removal  of  the  waste 
products  of  activity  cannot  keep  pace  with  the  rapid  con- 
sumption of  energy  in  the  accelerated  pulsations  ;  it  is  exhausted 
as  the  gymnotus  is  exhausted  when  it  has  been  provoked  to  re- 
peated electrical  discharges  and  can  give  no  more  shocks  until  it 
has  recruited  its  energies.  The  lowest  animal  forms,  which  seem 
not  to  sleep  at  all,  probably  sleep,  like  the  heart,  in  similar  brief 
snatches  of  rest.  The  organism  is  a  self-feeding  and  self-repair- 
ing machine,  but  it  cannot  do  its  repairs  when  it  is  in  full  work ; 
it  must  ha,ve  for  its  parts,  as  for  its  whole,  its  recurring  periods  of 
adequate  rest ;  and  the  time  comes  at  last  when,  like  any  other 
machine,  it  wears  out,  is  no  more  capable  of  repair,  and  when 
the  exhaustion  which  ensues  is  death — the  sleep  during  which 
there  is  no  rejoair  and  from  which  there  is  no  awaking. 

The  conditions  under  which  we  go  to  sleep,  the  causes  which 
promote  it,  and  the  ill  effects  which  follow  the  deprivation 
thereof,  are  proofs  of  its  true  purpose  in  the  animal  economy. 
When  we  wish  to  sleep  we  shut  out  all  external  stimuli,  as  a 
bird  puts  its  head  under  its  wing,  banish  all  subjects  of  active 
thought  or  feeling,  and  place  our  bodies  in  as  complete  a  state 
of  muscular  repose  as  possible :  so  sleep  comes  on  insensibly 
as  a  deeper  rest,  not  as  an  abrupt  change,  stealing  upon  us  as 
darkness  upon  daylight.  The  general  causes  which  produce  it 
are  such  as  exhaust  the  energy  of  the  nervous  system,  either 
through  suffering  or  doing,  and  so  occasion  fatigue  of  body  and 
mind ;  they  are  muscular  and  mental  exertion,  when  not  too 
prolonged,  the  weariness  which  follows  great  emotional  strain, 
when  not  too  intense,  and  severe  bodily  pain.  It  is  true  that 
we  may  by  a  strong  voluntary  effort,  or  under  the  spell  of  an 
excitement,  prolong  the  usual  period  of  waking,  and  resist  sleep, 
although  we  are  very  sleepy ;  but  we  cannot  do  so  indefinitely, 
for  torpor  and  incapacity  of  mental  function,  delirium,  and  death 
are  the  consequences  of  an  entire  deprivation  of  sleep. 

In  this  connexion  it  is  interesting  to  ask  why  we  awake — 
why,  once  asleep,  we  do  not  go  on  sleeping  for  ever  ?  Probably 
very  much  as  the  power  of  the  exhausted  electric  eel  to  give  a 
shock  revives  when  restoration  of  energy  has  taken  place  by 


1.]  SLEEP  AND  DREAMING.  3 

nutrition  during  rest.  A  stimulus  to  the  body,  of  external  or 
of  internal  origin,  which  would  have  been  unfelt  during  the 
deep  sleep  of  exhaustion,  or  would  have  only  been  enough  to 
occasion  a  dream,  suffices,  as  the  sleep  becomes  light  through 
restoration  of  energy,  to  awaken  the  individual  either  directly  or 
by  the  vividness  of  the  dream  which  it  occasions.  We  should 
not  sleep  for  ever,  I  believe,  if  every  external  stimulus  were 
shut  out ;  for  the  accumulation  of  nervous  energy  would  av/aken 
us  either  spontaneously,  or  on  occasion  of  the  least  internal 
stimulus,  which,  as  the  organic  functions  are  not  suspended, 
though  they  are  more  languid,  during  sleep,  could  not  be  shut 
out.  If  these  functions  regained  their  full  activity  they  might 
directly  cause  waking.  On  the  time  at  which  we  awake  habit 
notably  has  a  great  influence  within  certain  limits ;  when  we 
allow  the  nervous  system  so  many  hours  for  repose,  we  accustom 
it  to  that  allowance,  and  it  learns  to  do  its  repairs  within  the 
allotted  time. 

Of  what  are  the  physiological  accompaniments  of  the  occur- 
rence of  sleep  we  know  nothing  more  than  that  the  circulation 
of  blood  through  the  brain  is  lowered ;  not  as  cause  probably, 
but  as  coincident  effect  of  the  state  of  nerve-element.  Blumen- 
bach  long  agjo  took  notice  in  a  man  whose  skull  had  been  tre- 
panned  that  the  brain  swelled  with  blood  and  rose  into  the 
opening  when  he  was  awake  and  thinking,  and  sank  down  again 
when  he  fell  asleep ;  and  the  experiments  of  Mr.  Durham,  who, 
having  removed  circular  portions  of  the  skull  in  different  ani- 
mals, and  replaced  them  by  suitable  watch-glasses,  through 
which  he  could  observe  what  happened  when  the  animal  was 
awake  and  when  it  was  asleep,  convinced  him  that  there  was 
considerably  less  blood  in  the  brain  during  sleep ;  its  substance 
then  being  paler  and  sinking  down,  while  it  reddened  and 
became  turgid  directly  the  animal  awoke.  The  fontanelles  of 
young  children  sink  during  sleep  ;  and  forcible  compression  of 
the  carotid  arteries  in  the  neck  of  the  adult  will  induce  it.  There 
is  an  active  flow  of  blood  to  the  part  where  the  stimulus  of  func- 
tional energy  attracts  and  needs  it,  and  when  active  function  is 
suspended  by  the  recurring  necessities  of  restoring  the  expended 
energy  by  sleep,  the  circulation  of  blood  falls  to  the  level  of 


4  PATHOLOGY  OF  MIND.  [chap. 

the  mere  organic  requirements  of  the  brain  :  the  supply  answers 
in  fact  to  the  different  states  of  the  brain,  being  active  when  its 
functions  are  active,  moderate  when  thej  are  in  abeyance.  A 
short  step  further  has  been  made  in  conjecture.  Knowing  that 
different  parts  of  the  brain  are  supplied  with  blood  by  different 
arteries,  the  main  channels  of  which  go  on  dividing  and  sub- 
dividing into  smaller  channels  until  these  become  capillary,  it 
has  been  surmised  that  an  active  circulation  may  sometimes 
be  going  on  in  certain  vascular  areas  of  the  brain  while  the 
circulation  in  other  parts  of  it  is  lowered  to  the  level  of  sleep, 
not  otherwise  than  as  local  blushings  occur  elsewhere  in  the 
body  from  vaso-motor  dilatations,  and  that  these  active  local 
circulations  in  the  brain  are  the  conditions  of  that  modified  and 
irregular  activity  which  constitutes  dreaming :  one  part  of  the 
brain  is  supposed  to  be  more  or  less  awake  when  the  rest  of  it 
is  asleep. 

Eecently  the  theory  has  been  broached  that  sleep  is  caused 
by  the  accumulation  of  the  products  of  the  oxidation  which 
takes  place  during  activity ;  they  are  not  presumably  removed 
so  rapidly  as  they  are  produced  during  active  fimction,  but  are 
carried  away,  like  the  refuse  in  some  cities,  during  the  repose  of 
the  night.  It  is  not  known  what  is  the  exact  nature  of  these 
combustion-products,  but  it  is  assumed  that  they  act  upon  the 
nerve-elements  very  much  as  carbonic  acid  does,  causing  a  sort 
of  narcosis  when  they  accumulate.  Any  condition  then  which 
hinders  their  removal  from  the  brain,  such  as  prolonged  activity 
thereof,  will  favour  sleep ;  any  condition  which  accelerates  their 
removal  will  tend  to  prevent  it. 

Sleep  is  not  a  constant,  but  a  fluctuating  state.  There  are 
degrees  of  sleep,  not  only  of  the  cerebro-spinal  system  as  a 
whole,  but  of  its  different  parts — so  many  intermediate  steps 
between  it  and  waking ;  wherefore  we  may  be  rightly  said  to 
graduate  through  a  twilight-waking  into  imperfect  sleep,  and 
from  light  slumber  into  profound  unconsciousness.  It  is  hard 
to  say  sometimes  whether  we  have  been  asleep  or  not ;  for  the 
wandering  and  incoherent  ideas  and  the  suddenly  arising  hallu- 
cinations of  a  grotesque  kind  which  occur  just  as  we  are  going 
to  sleep  are  so  like  the  vagaries  of  dreams,  that  we  know  not  at 


1.]  SLEEP  AND  DREAMING.  5 

all  times  whether  they  were  part  of  our  waking  or  of  our  sleep- 
ing life.  The  stages  in  the  gradually  deepening  unconsciousness 
which  is  produced  by  opium  illustrate  very  well  the  gradations 
in  the  process  of  going  to  sleep :  there  is  first  a  drowsy  feeling 
which  becomes  soon  an  irresistible  inclination  to  sleep  ;  the 
person  then  falls  into  a  slumber  from  which  he  may  be  roused 
sufficiently  to  make  a  reply  to  a  question  put  to  him  in  a  loud 
voice,  thereupon  sinking  back  immediately  into  sleep,  which 
deepens  rapidly  into  a  comatose  unconsciousness  from  which 
the  severest  pinching,  slapping,  and  irritation  of  all  kinds  hardly 
avail  to  elicit  more  than  the  least  sign  of  feeling  or  the  briefest 
responsive  movement ;  finally  he  sinks  into  so  deep  a  coma  that 
he  is  insensible  to  anything  that  may  be  done  to  him ;  all  the 
tortures  which  savage  ever  devised  and  inflicted  upon  his  enemy, 
or  Christian  upon  his  fellow-believer  of  a  minutely  different 
shade  of  faith,  \vould  not  touch  him — he  is  in  the  unconscious- 
ness of  death  before  death.  One  sense  goes  to  sleep  after 
another,  each  sinking  gradually  into  a  deeper  slumber,  then 
tlie  spinal  cord,  and,  last  of  all,  the  respiratory  centre  in 
the  medulla  oblongata,  when  the  man  dies.  In  the  production 
of  insensibility  by  the  inhalation  of  chloroform  or  of  ether  we 
observe  e^^.dence  that  the  person  hears  after  he  can  no  longer  see, 
and  that  the  senses  of  taste  and  smell  are  lost  before  those  of  hear- 
ing and  touch ;  and  in  natural  sleep  it  is  obvious  that  there  are 
similar  gradations  of  unconsciousness,  one  sense  being  sometimes 
more  deeply  asleep  than  another,  or  the  spinal  cord  being  awake 
when  the  special  sensory  centres  are  fast  asleep.  A  lightly- 
sleeping  person  will  sometimes  hear  apt  questions  that  are  cau- 
tiously put  to  him  in  a  familiar  voice,  and  make  a  reply  without 
waking ;  and  there  can  be  no  doubt  that  a  man  will  sleep  on 
horseback  when  the  muscles  of  the  back,  among  other  muscles, ' 
must  be  in  action,  or  even  sometimes  when  walking ;  he  cannot 
sleep  when  standing  still,  because  the  body  will  be  sure  to  fall  for- 
wards unless  it  be  supported.  In  like  manner  when  we  awake, 
it  seldom,  if  ever,  happens  that  all  our  senses  awake  at  the 
same  instant;  a  sound  is  heard  before  the  other  senses  can 
receive  impressions  ;  indeed  they  appear  commonly  to  wake  suc- 
cessively.     When  we  consider  then  that  natural  sleep  is   not 


6  PATHOLOGY  OF  MIND.  [chap. 

really  a  fixed  aud  constant  quantity,  but  a  fluctuating  bodily 
state  in  whicli  there  are  considerable  differences  in  the  degree  of 
insensibility  of  different  parts,  some  being  lightly  and  others 
deeply  asleep  at  the  same  time,  it  will  not  appear  strange  that 
in  some  dreams  active  imagination  is  exhibited  and  skilful  bodily 
feats  performed ;  a  proof  that  some  mental  and  motor  centres  are 
awake  while  others  are  asleep. 

The  variations  of  susceptibility  of  different  parts  to  impressions 
during  sleep  is  shown  again  by  the  ease  with  which  a  sleeper 
may  be  awakened  by  a  gentle  sound  or  other  stimulus  to  which 
he  is  accustomed  to  respond,  when  a  louder  sound  or  other 
stimulus  that  is  really  more  powerful,  but  which  he  is  not 
accustomed  to  take  notice  of,  has  no  effect  upon  him.  In  sleep 
as  in  the  waking  state  the  ear  hears  best  what  it  expects  to 
hear.  Just  as  the  expectation  of  a  particular  impression  upon 
waking  sense  increases  the  susceptibility  of  that  sense  and  the 
rapidity  with  which  the  message  is  conveyed  from  the  external 
organ  to  the  central  ganglion,  so  the  adaptation  of  sleeping  sense 
to  a  particular  impression  engenders  a  habit  of  expectation,  so  to 
speak,  in  the  sense,  by  which  its  sensibility  to  the  impression  is 
heightened,  and  this,  though  gentle,  acts  upon  it  with  the  same 
efficacy  as  an  extraordinary  stimulus  would  do.  If  we  think  of 
it,  we  observe  that  in  our  daily  life  impressions  are  hourly  made 
upon  our  senses  of  which  we  are  not  in  the  least  conscious,  unless 
for  some  reason  or  other  we  are  moved  to  take  particular  notice 
of  them  ;  we  are,  as  it  were,  asleep  to  them  habitually  ;  and  it  is 
hard  to  conceive  what  potentialities  of  knowledge  some  of  these 
unperceived  impressions  contain,  and  what  opportunities  of  per- 
ception we  let  go  by.  We  live  actually  in  very  limited  relations 
with  external  nature — relations  limited  not  only  by  the  capacities, 
but  by  the  habits  of  our  senses — and  become  extremely  automatic 
in  our  reactions  to  the  few  stimuli  which  are  habitually  received  ; 
wherefore  our  intellectual  and  practical  life  runs  in  the  main  upon 
a  few  fixed  lines  to  which  we  are  bound,  as  animals  are  constrained 
by  their  particular  instincts,  and  outside  which  lie  vast  un- 
surveyed  regions.  We  perceive  only  what  we  attend  to,  and  we 
attend  only  to  that  to  which  we  have,  by  frequent  repetition,  or- 
ganised an  adaptation  of  sense  and  of  suitable  motor  associations. 


1.]  SLEEP  AND  DREAMING.  7 

Men  little  consider  how  mechanical  they  are.  in  their  thoughts, 
feelings,  and  doings.  So  fully  possessed  are  they  with  the  fixed 
but  erroneous  notion  that  consciousness  is  the  essential  agent  in 
all  the  purposive  things  which  they  do,  that  they  stand  amazed 
when  they  witness  any  evidence  of  intelligent  action  during  the 
abeyance  of  consciousness,  as  in  sleep,  and  look  upon  it  as  some- 
thing marvellous  ;  whereas  the  real  marvel  would  be  if  the 
organism  were  entirely  to  forget  its  intelligent  habits  simply 
because  they  were  not  lit  up  by  consciousness.  As  a  matter  of 
fact  it  does  not  forget  them  :  it  awakes  commonly  at  its  ac- 
customed hour  whether  the  person  went  to  bed  at  his  usual  hour 
or  later,  and  awakes  at  any  moment  on  the  occurrence  of  the 
least  sound  to  which  it  is  accustomed  to  awake,  as  when  the 
mother  hears  her  baby's  cry  in  the  night,  taking  no  notice  of  a 
much  louder  sound  which  it  has  learned  to  disregard  ;  and  it 
awakens  instantly  on  the  cessation  of  a  sound  to  the  continu- 
ance of  which  it  has  been  accustomed  in  sleep,  as  is  exemplified 
by  the  well-known  story  of  the  miller  who  awoke  when  the  noise 
of  his  mill,  which  went  on  through  the  night  usually,  ceased 
in  consequence  of  the  breakdown  of  the  machinery. 

It  has  been  a  disputed  question  whether  sleep  is  ever  quite 
dreamless,  and  opposite  answers  to  it  have  been  propounded. 
Some  writers  hold  that  no  state  of  sleep,  however  sound  it 
be,  is  without  dreaming ;  not  being  able  apparently  to  conceive 
two  different  states  of  sleep  so  remote  from  each  other  as  active 
dreaming  and  complete  suspension  of  mental  function ;  infected 
also  probably  in  some  degree  by  the  Cartesian  dogma  that  the 
mind  never  can  be  entirely  inactive.  Their  contention  is  that 
when  we  declare  we  have  not  dreamed,  the  truth  is  that  we  have 
dreamed  and  have  forgotten  it ;  and  they  adduce  in  support  of 
their  argument  such  undoubted  facts  as  these — the  rapid  and 
complete  way  in  which  the  most  vivid  dream  often  vanishes 
from  the  memory,  so  that,  although  we  awake  with  its  features 
clear  in  the  mind,  they  are  gone  in  a  few  minutes  and  cannot  be 
recalled  ;  the  quite  accidental  way  in  which  some  trivial  ex- 
perience of  the  day  will  sometimes  bring  back  the  recollection 
of  a  dream  which  we  had  entirely  forgotten,  and  which  but  for 
that  accident  we  should  have  forgotten  for  ever ;  and,  lastly,  the 


8  PATHOLOGY  OF  MIND.  [chap 

fact  that  other  persons  may  have  observed  in  our  exclamations 
and  movements  during  sleep  plain  evidence  that  we  have  dreamt 
when  we,  on  waking,  should  be  ready  to  assert  confidently  that 
we  had  not.  Due  weight  may  be  granted  to  these  facts  without 
admitting  that  they  go  the  length  of  proving  the  position  which 
it  is  sought  to  maintain.  The  weight  of  evidence,  in  a  case 
which  by  the  nature  of  things  cannot  be  decided,  I  believe  to  be 
really  on  the  side  of  the  opinion  that  the  soundest  sleep  is  a 
dreamless  sleep.  The  difficulty  of  conceiving  a  temporary  nullity 
of  mental  function  one  may  take  leave  to  dismiss  as  a  lingering 
prejudice  from  the  metaphysical  notion  of  mind  as  an  exalted 
spiritual  entity  whose  essence  has  nothing  in  common  with  the 
low  material  necessities  of  the  body.  When  we  make  the  matter 
one  of  observation,  it  cannot  be  denied  that  we  perceive  during 
sleep  all  shades  of  gradation  between  the  most  vivid  and  active 
dreaming  at  the  one  end  and  the  faintest  show  of  evanescent 
activity  at  the  other  end  of  the  scale.  A¥hat  difficulty  is  there, 
then,  in  passing  in  conception  the  imperceptible  line  between 
the  least  flutter  of  activity  and  a  complete  nullity  of  function  ? 
Turthermore,  in  certain  cases  of  suspended  animation  or  apparent 
death,  as,  for  instance,  when  a  person  is  taken  out  of  water  in  a 
completely  unconscious  state,  and  revives  only  after  energetic 
efforts  at  restoration  continued  for  an  hour  or  even  for  hours,  it 
is  as  certain  as  anything  can  well  be  that  all  mental  function 
was  abolished  from  the  moment  he  became  insensible  unto,  the 
moment  when  sensibility  returned.  Take  again  the  remarkable 
case  of  a  blow  on  the  head  producing  depression  of  the  skull, 
pressure  upon  the  brain  therefrom,  and  insensibility  therewith  ; 
with  the  raising  of  the  depressed  bone  by  surgical  means  the 
person  has  not  only  regained  consciousness  instantly,  but  has 
gone  on  to  finish  a  sentence  which  he  had  begun  when  he  was 
struck  down  unconscious.^  In  profound  apoplexy,  in  the  entire 
insensibility  which  is  produced  by  chloroform,  and  in  similar 

^  In  the  American  Jounial  of  Nervous  and  Mental  Diseases  for  April, 
1877,  Dr.  Hoy  mentions  the  case  of  a  youth,  aged  eighteen  years,  who  was 
struck  insensible  by  the  kick  of  a  horse,  his  skull  being  depressed  and 
fractured.  After  trephining  the  depressed  bone  he  became  sensible.  Dr. 
Hoy  took  advantage  of  the  hole  in  the  skull  to  make  firm  pressure  on  the 
exposed   brain   after   asking  him   a  question.      As  long  as  the  pressure 


I.]  SLEEP  AND  DREAMING.  9 

states  of  complete  unconsciousness  from  other  causes,  there  is 
not  the  least  reason  to  suspect  that  there  is  any  more  mental 
function  going  on  than  there  is  in  an  animal  which  has  been 
deprived  of  its  cerebral  hemispheres. 

.  Another  theory  which  has  been  broached  with  regard  to 
dreaming  is  that  we  only  dream  just  as  we  are  going  to  sleep  or 
just  as  we  are  coming  out  of  it — in  the  transition  state  into  and 
out  of  sleep.  But  this  opinion  seems  on  examination  to  be  less 
tenable  than  the  opinion  that  we  never  cease  to  dream  when  we 
are  asleep.  "Were  the  somnambulist  not  a  positive  refutation  of 
it,  observation  of  sleeping  persons  who  show  plainly  by  their 
actions  or  their  words  that  they  are  dreaming  and  who  still  go 
on  sleeping,  and  the  fact  that  we  sometimes  catch  ourselves  in 
the  midst  of  a  dream  when  we  are  roused  suddenly  out  of  deep 
sleep,  would  be  sufficient  to  prove  it  erroneous.  Inasmuch  as 
sleep  is  not  a  constant  but  a  fluctua.ting  state,  it  stands  to  reason 
that  there  will  often  be  varying  degrees  of  mental  function  ac- 
cording to  the  more  or  less  depth  and  completeness  of  it ;  there 
will  be  sometimes  an  activity  so  coherent  as  to  surprise  us,  at 
other  times  an  activity  of  the  most  partial  and  incoherent  kind, 
and  there  will  be  an  entire  abeyance  of  mental  function  during 
such  deep  sleep  as  that  which  fell  upon  Adam  when  the  opera- 
tion of  taking  a  rib  out  of  his  side  was  successfully  performed. 

It  has  been  justly  remarked  that  if  we  were  actually  to  do  in 
sleep  all  the  strange  things  which  we  dream  we  do,  it  would  be 
necessary  to  put  every  man  in  restraint  before  he  went  to  bed ; 
for,  as  Cicero  said,  dreamers  would  do  more  strange  things  than 
madmen.  A  dream  put  into  action  must  indeed  look  very  much 
like  insanity,  as  insanity  has  at  times  the  look  of  a  waking 
dream.  In  dreaming  as  in  insanity  there  are  the  most  strange 
and  grotesque  deviations  from  the  accustomed  sober  paths  of 

continued  he  remained  silent,  but  the  instant  it  was  removed  he  made  a 
reply,  never  suspecting  that  he  had  not  answered  at  once. 

The  same  gentleman  mentions  another  case  of  a  youth,  aged  nineteen, 
who  was  rendered  insensible  by  the  kick  of  a  mare  named  Dolly.  As  soon 
as  the  depressed  bone  w^as  removed,  he  cried,  "  Whoa,  Dolly,"  -with  great 
energy,  and  then  stared  about  him  in  amazement,  wondering  what  had 
happened  to  him.  Three  hours  had  passed  since  the  accident.  He  was 
not  conscious  the  mare  had  kicked  ;  the  last  thins:  which  he  remembered 
was  that  she  wheeled  round  her  heels  and  laid  back  her  ears. 


10  PATHOLOGY  OF  MIND.  [chap. 

associations  of  ideas ;  the  combinations  and  sequences  of  ideas 
do  not  follow  any  definite  laws,  so  far  as  we  can  discover,  but 
appear  often  to  be  quite  accidental  and  transitory ;  we  justly 
therefore  set  down  the  loss  of  all  power  over  the  succession 
of  ideas  as  one  of  the  leading  phenomena  of  dreaming.  It 
is  not  true,  however,  as  is  sometimes  said,  that  volition  is 
always  abolished  during  dreaming  ;  for  it  is  certain  that  we  may 
wake  up  suddenly  out  of  sleep  in  consequence  of  a  strong  effort 
of  volition  which  we  have  made  in  our  dream,  as  when  we 
strike  out  at  a  person  who  has  insulted  or  assaulted  us,  and 
that  at  other  times  we  do  voluntarily  restrain  the  expression 
of  our  feelings.  I  have  been  brought  to  the  very  verge  of  being 
hanged  on  two  or  three  occasions  in  my  dreams,  having 
wakened  up  at  the  last  moment  before  the  operation  was  to 
be  performed,  and  on  each  occasion  I  have  been  conscious  of 
a  determined  suppression  of  any  betrayal  of  fear  or  other 
emotional  agitation  during  the  preparations  for  the  event.  A 
concrete  act  of  volition  of  that  sort  is  not  impossible  in 
dreams.  It  is  a  fair  question,  however,  how  far  we  succeed 
in  accomplishing  the  volition  when  it  is  to  do  something 
active,  and  how  near  waking  we  are  when  we  feel  it.  For 
it  happens  in  dreams  that  we  find  ourselves  straining  to  do 
something — for  example,  to  strike  a  blow,  to  cry  for  aid,  to 
utter  a  command,  and  are  perfectly  impotent  to  do  it ;  and 
the  instant  we  succeed  in  liberating  our  paralysed  energies 
we  awake.  There  is  the  strongest  mental  volition,  but  an 
utter  impotency  of  motor  outcome ;  the  instant  which  elapses 
between  the  desire  or  will  to  do  and  the  waking  state  being 
long  enough  for  the  occurrence  of  what  seems  a  much  longer 
drama  of  impotence  in  the  dream.  At  the  same  time  it 
should  not  be  overlooked  that  a  person  does  not  always 
awake  who  calls  out  in  his  dream,  and  that  we  remember 
dreams  in  which  we  imagined  ourselves  to  will  and  to  do 
what  we  willed. 

Certainly  it  is  true  that  volition  in  its  highest  sense  of 
control  over  the  mental  operations  is  abolished  in  dreaming, 
as  a  moment's  reflection  will  show  must  needs  be  the  case. 
For  such  volition  is  neither  more  nor  less  than  the  expression 


I.]  SLEEP  AND  DEEAMING.  11 

of  the  fullest  co-ordinate  activity  of  the  mental  functions, 
varying  much  in  quality  necessarily  according  to  the  develop- 
ment of  the  functions  through  previous  training,  and  cannot 
therefore  by  the  nature  of  the  case  consist  with  the  fortuitous 
concourse  of  ideas  in  dreams.  It  is  impossible  there  can  be 
full  use  of  reflection  when  most  of  the  habitual  trains  of 
thought  are  suspended  in  sleep  ;  an  idea  that  is  accompanied 
with  desire  is  without  the  means  of  becoming  a  reasoned  volition 
in  the  ordinary  way ;  it  must  remain  a  particular  desire,  and 
when  it  is  active,  instead  of  the  natural  results  following 
through  the  beaten  paths  of  association,  it  will  rouse  some 
strange,  apparently  unrelated  idea,  which  being  seen  as  a  vision 
will  present  itself  as  a  sort  of  abrupt  transformation  scene. 
For  the  same  reason  the  sense  of  personal  identity,  the  unity  of 
individual  character,  is  confused  and  seemingly  lost.  We  are 
ourselves  and  somebody  else  at  the  same  moment,  as  other 
persons  seem  to  be  themselves  and  not  themselves,  and  we  do 
absurd  and  perhaps  transcendently  criminal  things  in  the  most 
matter-of-fact  way,  all  the  while  mildly  surprised  or  not  at  all 
surprised  at  ourselves  for  doing  them.  How  can  there  be  a 
clear  sense  of  the  unity  of  the  ego,  how  any  conscience,  when 
there  is  an  entire  abeyance  of  that  co-ordination  of  mental 
function,  the  self-consciousness  of  which  is  the  feeling  of 
personal  identity  ?  It  is  probable  enough  that  when  we  begin 
in  our  dreams  to  be  surprised  at  the  change  of  identity,  and 
to  think  about  it  as  odd,  we  are  on  the  point  of  waking ;  the 
commencing  restoration  of  the  co-ordination  of  functions  being 
in  fact  the  restoration  of  the  feeling  of  identity  and  the  occasion 
of  our  surprise.  But  it  seems  to  me  that  throughout  all  the 
vagaries  of  dreaming  there  is  generally  at  bottom  an  obscure 
feeling  or  instinct  of  identity,  or  else  we  should  not  ever  be 
surprised  at  ourselves  when  we  seem  not  ourselves,  or  when  we 
are  doing  extraordinary  things,  or  even  have  the  sort  of  personal 
feeling  which  we  have  in  whatever  odd  drama  we  may  be 
playing  a  part.  The  reason  I  believe  to  be  that  the  organism 
preserves  its  identity  notwithstanding  that  our  conscious  func- 
tions are  in  the  greatest  distraction ;  although  we  are  asleep  the 
different  impressions  of   our  organic    or    systemic   sensibility, 


12  PATHOLOGY  OF  MIND.  [chap. 

which  are  not  affected  directly  by  external  conditions,  are  carried 
to  the  brain  from  the  internal  organs  ;  and  it  is  this  physiological 
unity  of  organic  functions,  which  is  something  deeper  than 
consciousness  and  constitutes  our  fundamental  personality,  that 
makes  itself  felt  with  more  or  less  force  in  every  conscious  state, 
dreamiog  or  waking.  The  insane  inmate  of  a  pauper  lunatic 
asylum  who  is  possessed  with  the  delusion  that  he  is  the  Almighty 
and  can  do  in  an  instant  whatever  he  wills,  begs  humbly  a  trifl- 
ing favour  at  the  same  moment  that  he  proclaims  his  omnipo- 
tence.    Such  are  the  inconsistencies  of  a  distracted  identity. 

The  absence  of  surprise  at  the  extraordinary  events  which 
take  place  in  dreams  is  sometimes  very  remarkable.  But  it  is 
not  always  complete.  In  some  instances  there  is  a  partial  or 
particular  surprise ;  not  a  surprise  springing  from  a  consistent 
reflection  upon  the  absurdity  of  the  whole  affair,  such  as 
a  waking  man  would  make,  but  a  surprise  at  a  particular 
startling  inconsistency,  as,  for  example,  at  the  appearance  of  a 
person  whom  we  remember  to  be  dead,  to  take  part  in  the  events 
of  the  dream.  On  other  occasions,  there  may  be  distinct  feeling 
that  we  are  dreaming ;  we  may  say  to  ourselves—  It  is  only 
a  dream  ;  and  perhaps  resolve  at  the  same  time  to  go  on  with  it 
instead  of  breaking  the  spell,  as  we  feel  we  might  do  at  any 
moment.  When  there  is  not  so  distinct  a  consciousness  that  the 
affair  is  a  dream,  there  is  now  and  then  a  half- conscious  under- 
tone of  question  or  doubt  of  the  reality  of  the  images  which 
flit  before  the  mental  vision :  a  sort  of  dim  and  vague  feeling 
of  their  unreality,  as  if  they  were  parts  of  a  dramatic  show  in 
which  we  were  so  much  interested  for  the  time,  so  far  carried 
away,  as  to  lose  independence  of  judgment  and  even  sense  of 
individuality.  If  this  feeling  becomes  stronger  it  probably 
produces  the  conviction  that  we  are  dreaming  which  we  have 
sometimes  before  we  awake,  and  in  the  end  awakens  us.  For  I 
imagine  that  we  are  very  near  waking  when  we  get  this  con- 
viction :  that  the  co-ordinated  functions,  from  the  consentience 
of  which  springs  the  consciousness  of  identity,  are  beginning 
to  be  exercised.  The  dream-phantoms  move  across  a  back- 
ground of  the  unconscious  individuality,  which,  moulded  and 
fashioned  by  the  habit  of  our  life-experience,  necessarily  con- 


I.]  SLEEP  AND  DEEAMING.  13 

tradicts  tliem  absolutely  the  moment  it  becomes  conscious,  and 
gives  rise  when  only  in  a  state  of  nascent  consciousness  to  the 
vague  subconscious  feeling  of  scepticism  before  it  declares  them 
positively  unreal.  It  is  impossible  we  should  be  surprised  at 
the  inconsistencies  of  a  dream  when  we  are  in  deep  sleep, 
because  it  is  impossible  we  should  then  reflect — in  other  words, 
impossible  we  should  compare  them  with  those  organised  mental 
experiences  which  are  the  registrations  of  our  observations  of  the 
order  of  nature,  seeing  that  these  experiences  are  silent ;  it 
would  be  a  wonder  therefore  if  we  did  not  accept  as  real,  and 
without  surprise,  the  vagaries  of  dreams. 

The  idea  which  arises  in  the  mind  in  a  dream,  being  unable 
to  follow  the  accustomed  paths  of  reflection,  acts  downwards 
upon  the  sensory  ganglion,  and  takes  shape  as  a  distinct  image 
or  an  actual  perception,  so  that  a  dream-train  of  ideas  is  a  train 
of  images.  Moreover  it  is  an  image  which  we  see  very  vividly, 
because  there  is  no  distraction  of  consciousness  by  objects  of 
external  sense  or  by  related  ideas,  as  we  see  the  stars  from  the 
bottom  of  a  deep  well  in  broad  daylight  because  the  line  of 
vision  alone  is  then  illuminated.  The  result  is  that  what  would 
be  a  succession  of  ideas  in  the  waking  state,  hardly  perhaps 
overstepping  the  threshold  of  consciousness,  becomes  a  disorderly 
succession  of  images,  or,  as  it  were,  a  series  of  abrupt  transfor- 
mation scenes  in  a  drama.  Taking  Hobbes'  celebrated  instance 
of  association  of  ideas,  one  might  consider  curiously  what  it 
would  become  supposing  it  were  to  occur  in  a  dream.  "  For  in 
a  discourse,"  he  says,  "of  our  present  civil  war,  what  would 
seem  more  impertinent  than  to  ask,  as  one  did,  what  was  the 
value  of  a  Eoman  penny  ?  Yet  the  coherence  to  me  was 
manifest  enough:  for  the  thought  of  the  war  introduced  the 
thought  of  the  delivering  up  of  the  king  to  his  enemies ;  the 
thought  of  that  brought  in  the  thought  of  delivering  up  Christ ; 
and  that  again  the  thought  of  the  thirty  pence,  which  was  the 
price  of  that  treason ;  and  thence  easily  followed  the  malicious 
question  "  (Leviathan,  i.  ch.  iii.).  In  the  dream  there  would  be 
so  many  scenes  rapidly  following  one  another,  or  jumbled  con- 
fusedly together,  and  when  the  dreamer  awoke  and  called  to 
mind  the  details  of  his  dream,  he  might  be  at  a  loss  to  account 


14  PATHOLOGY  OF  MIND.  [cii.ip. 

for  the  strange  conjunction  of  persons  and  incidents  in  the  spec- 
tacles that  had  been  presented  to  him,  and  for  the  sudden  trans- 
formation of  one  spectacle  into  a  quite  different  one.  And 
whereas  in  this  case  we  suppose  that  there  were  true,  though 
unperceived,  links  of  association  between  the  ideas,  for  which 
reason  the  scenes  did  not  follow  one  another  without  coherence, 
it  is  probable  that  in  many  dreams  the  ideas  Avhich  become 
transformed  into  images  call  up  one  another  in  a  fortuitous  way, 
and  so  produce  more  incongruous  scenes. 

The  fantastical  deviations  from  the  ordinary  tracks  of  associa- 
tion of  ideas,  the  loss  of  volitional  power  over  the  ideas,  the  sus- 
pension of  conscience,  the  distraction  of  the  ego,  and  the  seem- 
ing reality  of  the  grotesque  dream  are  all  parts  of  the  same 
effect ;  tliey  proceed  from  a  discontinuity  of  function  in  the 
supreme  centres  of  the  brain,  a  temporary  suspension  of  the 
bonds  of  their  functional  unity.  As  when  a  complex  assemblage 
and  series  of  movements  which  have  been  trained  to  the  execu- 
tion of  certain  complicated  and  special  effects  can  no  longer  be 
performed  because  of  some  disorder  in  the  proper  motor  centres, 
but  in  their  stead  spasmodic,  incoherent,  and  purposeless  move- 
ments are  displayed,  we  might  say  that  the  usual  motor  associa- 
tions were  broken  up,  volitional  power  abolished,  and  their 
essential  identity  as  specially  purposive  functions  destroyed,  so 
it  is  with  the  co-ordinated  functions  of  the  supreme  cerebral 
centres  in  dreaming  ;  its  phenomena  express  different  degrees  of 
loss  of  co-ordination — that  is  to  say,  different  stages  in  the 
resolution  or  disintegration  of  the  most  complex  integrations  of 
mental  evolution. 

It  is  sometimes  said  that  in  dreaming  there  is  a  loss  of  the 
faculty  of  combining  and  arranging  ideas.  True  it  is  that  there 
is  usually  a  loss  of  the  faculty  of  combining  and  arranging  them 
as  we  do  when  we  are  awake  ;  but  one  of  the  most  remarkable 
features  of  dreaming,  which  has  hardly  had  the  consideration 
which  it  deserves,  is  the  singular  power  of  combining '  and 
arranging  ideas  into  the  most  vivid  dramas.  It  would  be  no 
great  exaggeration  to  say  that  the  dramatic  power  of  a  dunce  in 
dreaming  exceeds  that  which  is  displayed  by  the  most  imagina- 
tive writer  in  his  waking  state.      When  we  reflect  upon  the 


1.]  SLEEP  AND  DKEAMING.  15 

extraordinary  creations  of  dreams,  and  consider  that  the  most 
stupid  and  unimaginative  person  often  constructs  scenes,  creates 
characters,  and  contrives  events  with  a  remarkable  intensity  of 
conception,  distinctness  of  outline,  and  exactness  of  details, 
putting  into  the  mouths  of  his  dramatic  persons  dialogues  suited 
to  their  several  characters,  we  might  well  conclude  that  there  is, 
independently  of  will  or  consciousness,  a  natural  tendency  of 
ideas,  however  stirred,  to  combine  and  to  arrange  themselves  into 
a  kind  of  drama,  even  though  they  have  no  known  associations 
and  appear  quite  independent  of,  if  not  antagonistic  to,  one 
another.  Ideas  in  this  respect  might  be  compared  rudely  to 
such  chemical  substances  as,  the  moment  they  are  set  free  to 
yield  to  their  affinities,  rush  together  to  form  a  compound  of 
some  kind.  The  same  sort  of  thing  occurs  in  the  w^aking  state 
when  the  succession  of  thoughts  is  not  controlled  by  reflection 
upon  some  definite  subject,  and  it  constitutes  the  chief  part  of 
the  mental  activity  of  a  great  number  of  persons  who,  when  not 
engaged  in  practical  work,  spend  their  time  in  vacant  reverie, 
or  in  rambling  incongruities  of  ideas.  Were  a  faithful  record 
kept  of  the  fantastical  play  of  ideas  under  these  circumstances, 
it  would  often  read  as  wild  as  any  dream.  The  point,  however, 
w^hich  I  desire  to  lay  stress  upon,  and  to  fix  attention  to  here, 
is  the  tendency  of  ideas,  however  unrelated,  to  come  together, 
and  to  form  some  sort  of  mental  imagery,  wildly  absurd  or  more 
or  less  conformable  to  nature — the  actual  constructive  power 
w^hich  they  evince  ;  for  it  plainly  indicates  that  the  plastic  power 
of  mind,  its  so-called  imagination,  is  at  bottom  organic  function 
of  the  supreme  cerebral  centres ;  something  which,  being  dis- 
played when  will  is  in  abeyance  and  consciousness  a  mere 
gleam,  whenever  there  is  the  least  display  of  cerebral  mental 
function,  must  plainly  lie  beneath  consciousness  and  beneath 
will.  It  is,  if  you  will,  unconscious  mental  function.  It  is  not 
merely  an  association  of  ideas,  and  is  not  explained,  as  some 
persons  seem  to  think,  wdien  it  is  referred  to  that  so-called 
principle,  to  which  they  are  in  the  habit  of  attributing  extra- 
ordinary powders.  The  principle  of  association  of  ideas  is  nothing 
more  than  the  statement  that  ideas  which  have  occurred  together 
or  in  sequence,  or  wdnch  have  something  like  in  them,  will 
2 


16  PATHOLOGY  OF  MIND.  [chap. 

probably  occur  together  again,  one  calling  up  the  other.  But 
we  are  dealing  with  something  more  than  that — with  an  actual 
constructive  agency,  whereby  ideas  are  not  brought  together 
only,  but  new  products  are  formed  out"  of  them.  The  scene 
presented  may  be  one  which  has  never  been  actually  ex- 
perienced, nor  is  it  always  made  up  by  the  combination  of 
images  which  have  been  experienced.  Both  the  scene  and  the 
images  are  many  times  new,  though  suggested  by  similar  scenes 
or  images  seen  in  part  or  in  whole. 

It  is  noteworthy  in  this  relation  how  in  dreams  a  general  idea 
is  resolved  into  suitable  concrete  images,  such  as  it  might  have 
been  derived  from  by  abstraction,  but  which  it  never  was  actually 
derived  from,  although  no  doubt  it  was  the  abstract  of  somewhat 
similar  experiences.  A  casual  suggestion  in  the  day — for  instance, 
that  a  person  has  great  tact  or  great  courage,  may  be  the  occa- 
sion of  his  taking  part  in  the  scenes  of  a  dream,  and  doing  things 
which  we  should  consider  to  evince  tact  or  courage,  notwith- 
standing that  the  scenes  are  entire  creations  of  fancy  and  such 
as  he  never  could  have  mixed  in.     The  general  idea  creates  the 
scenes  of  its  appropriate  display,  being  resolved  as  it  were  into 
the  concrete  elements  out  of  which  it  might  have  been  developed. 
This   is  an   entirely  involuntary   operation,  and  proves,   as  is 
proved  also  by  the  formation  of  the  general  idea  in  the  lirst 
instance — not  in  the  least  a  voluntary  procedure — that  mind  is 
capable  of  those  intelligent  functions  which  are  the  essence  of 
its  being,  independently  of  will  and  of  consciousness,  or  at  any 
rate  that  the  potentiality  of  them  lies  not  in  consciousness  nor 
in  will,  but  in  the  plastic  quality  of  the  brain.     As  the  unknown 
organic  power  in  a  living  cell — whatever  complexity  of  intimate 
physico-chemical  processes  its  vitality  may  connote — assimilates 
what  is  suitable  to  its  growth  in  its  surroundings,  and  so  builds 
up  by  degrees  an  individual  being  in  conformity  with  the  lines 
of  development  that  are  laid  in  its  nature ;  so  the  special  organic 
power  of  the  nerve-elements  in  the  supreme  centres  of  the  brain 
builds  up  by  degrees  in  adaptation  to  the  co-existences  and 
sequences  of  the  surroundings,  social  and  physical,  the  complex 
structure  of  the  mental  organisation  of  the  individual.     But  it 
cannot  transcend  the  lines  that  are  laid  down  for  it  in  the 


I.]  SLEEP  AND  DREAMING.  17 

inborn  capacities  of  the  individual  nature  ;  what  the  mental 
organisation  will  turn  out  to  be  will  depend,  first  and  foremost, 
upon  the  inborn  capacities  which  he  has  inherited  from  ances- 
tors, and,  secondly,  upon  the  influence  of  education  and  of  the 
circumstances  of  life.     As  with  the  seed  of  a  tree  dropped  in  a 
forest :  its  original  germ-force  may  be  greater  or  less,  its  situa- 
tion more  or  less  favourable,  but  it  will  take  root  and  flourish, 
and  surpass  other  trees  in  growth,  according  to  the  advantage  of 
the  position  in  which  it  has  chanced  to  drop,  and  according  to 
the  power  which  it  has,  through  original  strength  of  stock,  of 
profiting  by  opportunity  and  getting  the  most  out  of  its  sur- 
roundings.    We  rightly  look  upon  mind  as  the  highest  force  in 
nature,  but  we  are  wrong  to  look  upon  it  as  a  power  outside  of 
and  above  nature,  self-sufficing,  without  relations  of  dependence 
or  affinity  ;  while  looking  up  to  the  height  of  its  noblest  func- 
tions, we  ought  not  to  overlook  the  depths  in  which  their  roots 
are  planted.    The  intellect  is  developed  out  of  sensation  and 
motion,  in  other  words,  out  of  the  capacity  to  receive  and  assimi- 
late suitable  impressions  and  to  respond  to  them  by  definite 
movements,  whereby  man  as  a  part  of  nature  takes  his  part  in 
its  evolution,  being  acted  upon  by  it  and  reacting  upon  it ;  and 
will  is  the  impulse  which,  springing  at  bottom  from  the  organic 
life  and  displaying  itself  in  desire,  is  guided  by  the  intellect  to 
effect  improved  conscious  adjustments  to  the  social  and  physical 
environments.    But  the  capacity  to  receive  and  assimilate  suitable 
impressions,  and  to  reject  and  eschew  unsuitable  impressions,  is 
nowise  a  peculiar  mental  endowment ;  it  is  a  fundamental  pro- 
perty of  organic  element.     Man  is  not  a  mixture  or  a  compound 
of  body  and   mind,   but  one  being,  having,  magnet-like,  two 
polarities — the  one  linking  him  to  that  which  is  below  him,  the 
other,  representing  his  spiritual  aspirations,  having  opposite  and 
higher  attractions. 

The  plastic  power  of  the  supreme  cerebral  centres  on  which  I 
insist  as  something  deeper  than  conscious  mental  function, 
evinces  its  spontaneous  and  independent  nature  in  a  striking 
way  by  those  singularly  coherent  dreams  which  everybody  has 
at  one  time  or  another,  and  in  which  he  sometimes  puts  forth  as 
much  intellectual  power  as  he  ever  displays  when  awake.  Many 


18  PATHOLOGY  OF  MIND.  [chap. 

stories  have  been  told,  on  good  authority,  of  persons  who  have 
in  their  sleep  composed  poems,  solved  hard  problems  in  mathe- 
matics, discovered  the  key  of  a  perplexing  difficulty,  or  done 
like  wonderful  things ;  and  while  bearing  in  mind  that  dream 
achievements  which  seem  to  us  very  clever  at  the  time  prove 
oftentimes  to  be  nonsense  when  we  awake,  it  may  be  granted 
that  one  who  is  fitted  by  natural  abilities  and  training  to  do 
good  intellectual  work  when  awake  may  occasionally  chance  to 
do  it  in  sleep,  getting  the  good  of  a  good  understanding  even  in 
his  dreams.  These  instances  illustrate  the  spontaneous  nature 
of  the  process  of  creative  activity,  with  which  consciousness  and 
will  have  no  more  to  do  as  active  agents  than  with  the  imagina- 
tive creations  of  the  inspired  poet ;  for  it  is  only  when  the  pro- 
ducts are  formed  that  they  rise  into  clear  consciousness,  and  only 
when  they  are  known  that  they  can  be  willed.  Another  fact  in 
regard  to  the  dramatic  power  displayed  in  dreaming  which 
should  not  pass  unnoticed  is  the  apparent  rapidity  of  its  action, 
whereby  is  presented  in  an  instant  what  would  take  us  perhaps 
hours  to  think  out  consciously,  or  to  describe  adequately  in 
words.  A  tragedy  or  comedy  of  several  acts  is  devised  and 
performed  in  a  moment ;  it  is  no  great  wonder  therefore  that  it 
does  not  occur  to  one  whose  conscious  ego  is  in  abeyance  that 
he  is  the  author  of  the  various  characters  that  figure  in  it  and  of 
the  scenes  in  which  they  play.  He  assists,  happy  or  distressed, 
applauding  or  condemning,  at  a  spectacle  which  is  all  his  own 
creation,  and  has  not  the  will  or  the  power  to  modify  its  course 
in  the  least. 

One  matter  more  in  relation  to  the  mental  power  of  the 
dreamer  I  shall  take  notice  of,  namely,  the  singularly  vivid 
recollection  which  is  sometimes  shown  of  things  of  which  he 
has  not  the  least  remembrance  perhaps  in  the  waking  state. 
lie  can  lay  under  contribution  the  long  unused  stores  of 
memory,  draw  from  them  things  new  and  old,  and  so  give 
variety  to  his  scenes  in  a  way  the  waking  person  cannot  do  by 
any  strain  of  conscious  recollection ;  for  the  details  of  events 
long  past,  the  feelings  that  accompanied  them,  the  features  of  a 
face  long  dead,  the  tones  of  a  voice  that  is  still,  are  reproduced 
with  a  surprising  vividness  and  accuracy.     This  fact,  which  has 


I.]  SLEEP  AND  DREAMING.  19 

its  parallel  in  the  experience  of  delirium  and  in  the  momentary 
flash  of  recollection  which  occurs  just  before  the  unconscious- 
ness of  drowning,  goes  to  show  certainl}^  first,  that  there  is  no 
such  thing  as  forgetting  wliat  we  have  once  attentively  observed 
and  made  part  of  our  mental  experience,  and  secondly,  how 
little  consciousness  has  to  do  as  agent  in  the  essential  parts  of  the 
functions  of  recollection  and  imagination.  When  we  are  awake 
our  mental  energies  are  engrossed  in  certain  lines  of  habitual 
activity  which  are  determined  by  our  usual  pursuits  and  experi- 
ences— thej  run  in  certain  customary  tracks,  to  which  con- 
sciousness is  almost  exclusively  attracted ;  for  habits  and 
external  impressions  control  and  determine  our  thoughts  much 
more  than  we  think,  so  that  in  the  deepest  reverie  they  never 
get  so  far  a-field  as  when  all  external  impressions  are  shut  out. 
But  when  we  are  asleep  and  no  external  impressions  are  per- 
ceived, the  tracks  of  habitual  function  are  not  pursued,  ideas 
are  aroused  independently  of  their  associations  by  physical 
causes,  and  there  is  not  consequently  a  corner  of  the  brain  in 
which  there  is  a  memory  registered  that  may  not  be  stirred  into 
unwonted  activity.  Inasmuch  as  there  is  then  nothing  to  dis- 
tract consciousness  from  the  idea  which  emersjes  into  momen- 
tary  activity,  it  is  remarkably  vivid ;  and  inasmuch  as  its  related 
ideas  are  at  rest,  there  is  no  correction  of  it  and  it  stands 
out  in  exaggerated  proportions. 

In  searching  then  for  an  explanation  of  the  remarkable 
revivals  of  forgotten  events  in  dreams  we  must  take  into 
account — (1)  The  absence  of  external  impressions  linking  the 
mind  to  certain  tracks  of  habitual  function  which  would  not  be 
calculated  to  lead  to  the  forgotten  events,  and,  as  a  probable 
concomitant  effect,  the  opening  up  of  disused  or  neglected 
tracks  which  might  lead  to  them ;  (2)  the  direct  stimulation  of 
the  remotest  nerve  elements  through  the  circulation  of  blood, 
which,  flowing  in  multitudes  of  minute  channels  through  the 
most  intimate  recesses  of  the  structure  of  the  brain,  will, 
according  to  its  variations  in  quantity  and  quality  and  in  rapidity 
of  flow,  stimulate  into  activity  the  nerve-cells  with  which  it  is  in 
relation,  and  obviously  act  indifferently  upon  the  most  remote 
and  most  recent  registrations ;  and  (3)  the  probable  stimulation  by 


20  PATHOLOGY  OF  MIND.  [chap. 

some  internal  organ  of  the  body  of  that  part  of  the  brain  with 
which  it  is  in  special  internuncial  relation,  or,  in  other  words,  in 
which  it  has  cerebral  representation. 

"Whatever  the  explanation,  the  fact  is  indisputable  that  persons 
recall  in  dreams  names  and  things  which  they  had  entirely  for- 
gotten, and  which,  while  remembering  them,  they  are  not  perhaps 
conscious  are  remembrances  ;  just  as  thoughts  in  the  day  which 
appear  as  new  acquisitions  may  be  found  to  have  been  entertained 
before,  or  to  have  been  derived  from  some  book  which  was  read 
long  ago.  Maury  relates  the  following  amongst  other  instances. 
In  his  early  years  he  visited  Trilport,  a  village  on  the  Marve, 
where  his  father  had  built  a  bridge.  Later  in  life  he  dreamed 
once  that  he  was  a  child  playing  at  Trilport,  and  that  he  saw 
a  man  clothed  in  a  sort  of  uniform,  whom  he  asked  what  was 

his  name.     The  man  replied  C ,  and  that  he  was  gatekeeper 

at  the  bridge,  and  disappeared.     Maury  awoke  with  the  name 

C in  his  ears,  which  he  did  not  in  the  least  remember  ever 

to  have  heard.  Some  time  afterwards,  however,  he  inquired  of 
an  old  servant,  who  had   been  in  his  father's  service,  if  she 

recollected  a  person  named  C ;  and  she  replied   instantly 

that  he  w^as  gatekeeper  at  the  Marve  when  the  bridge  was  built. 
Dreams  themselves  are  notably  soon  forgotten,  partly  no  doubt 
because  of  the  little  concern  which  they  have  with  the  real 
experience  of  life,  and  partly  because  of  their  incoherent 
character :  we  cannot  recollect  one-hundredth  part  of  what  we 
see  and  hear  and  feel  and  think  and  do  in  a  day,  and  should 
be  very  unwise  to  attempt  to  do  so  within  the  conditions  of  our 
limited  capacity  of  memory  and  of  our  short  span  of  life ;  and 
whoever  will  listen  for  a  few  minutes  to  the  utterly  incoherent 
talk  of  a  thoroughly  demented  lunatic,  with  the  resolution  to 
remember  and  repeat  it  immediately  afterwards,  will  learn  by 
his  failure  how  much  incoherence  hinders  recollection. 

We  see  in  our  dreams  multitudes  of  faces  which"  we  do  not 
in  the  least  remember  to  have  seen  when  awake  :  do  we  invent 
them,  or  do  we  recall  actually  experiences  which  have  been  for- 
f^otten  ?  It  is  certain  that  an  inhabitant  of  any  large  and  busy 
city  sees  in  a  few  days  hundreds  of  faces  which  he  never  coula 
voluntarily  recall,  and  it  is  possible  that  some  of  these  may 


1.]  SLEEP  AND  DEEAMIXa.  21 

come  back  from  time  to  time  as  dream  faces.  It  seems  to  be  pretty 
certain  too  that  the  face  of  one  dream,  not  remembered  in  the 
waking  state,  may  appear  and  be  remembered  in  a  subsequent 
dream.  Dream  faces  may  then  be  reproductions,  not  inven- 
tions; but  it  is  more  probable  that  we  invent  them,  just  as  we 
invent  scenes  and  events,  and  even  words  which  we  imagine  we 
understand  clearly,  but  which  are  apt  enough,  if  they  remain  in 
our  ears  when  we  awake,  to  turn  out  to  be  nonsense.  The  action 
of  imagination  in  dreams  as  in  the  waking  state  is  doubtless 
productive  as  to  form,  reproductive  as  to  material 

Passiug  now  from  these  general  observations  and  reflections 
concerning  dreams,  I  go  on  to  inquire  into  the  causes  and 
conditions  which  seem  to  determine  their  oricrin  and  their 
character ;  and  I  propose  to  consider  and  class  them  under  six 
principal  headings,  rather  for  convenience  of  discussion  than 
because  the  conditions  are  separate  in  fact  and  can  be  separated 
in  their  working.     These  are  : — 

(1)  Character  and  precedent  mental  experience. 

(2)  Impressions  on  a  special  sense. 

(3)  The  state  of  tlie  muscular  sensibility. 

(4)  Organic  or  systemic  impressions. 

(5)  Conditions  of  cerebral  circulation, 

(6)  The  state  or  tone  of  the  nervous  system. 

1.  Character  and  Precedent  Mental  Eo:perience. — ^We  should 
plainly  never  dream  at  all,  but  sleep  the  dreamless  sleep  of  the 
newborn  infant,  had  we  not  some  mental  experience  to  draw 
upon :  the  material  of  our  dream-fancies,  the  elements  out  of 
which  new  products  are  formed,  we  derive  from  experienca  It 
is  a  common  observation  that  the  thou£^hts  and  feeling^s  of  the 
day  reappear  under  various  guises  in  dreams,  the  more  probably 
the  more  vi\adly  they  have  affected  us  at  the  time ;  and  some 
persons  are  so  susceptible  that  any  strong  feeling  or  conception 
which  they  have  had  in  the  day  is  sure  to  make  itself  felt  in  a 
dream  at  night.  Certainly  most  use  is  made  for  dream  imagery 
of  immediately  antecedent  or  comparatively  recent  experiences, 
which  are  revived  by  direct  associations,  old  experiences  be- 
coming indistinct  and  perhaps  even  extinct  sometimes ',  still  it 


22  PATHOLOGY  OF  MIND.  [chap. 

is  remarkable  how  vividly  we  revert  now  and  then  to  long 
distant  and  forgotten  experiences  of  persons,  places,  and  the  like, 
either  on  the  occasion  of  some  chance  stimulus  in  the  day  to  old 
associations,  or  in  consequence  of  some  unusual  perturbation 
of  the  bodily  state  stirring  their  substrata  into  activity.  Dr- 
Darwin  mentions  the  case  of  a  gentleman  who,  having  been  so 
deaf  for  thirty  years  that  he  could  be  conversed  with  only  in 
writing  or  by  the  finger  alphabet,  assured  him  that  he  never 
dreamt  of  persons  conversing  with  him  except  by  the  fingers  or 
in  writing,  and  had  never  had  the  impression  of  hearing  them 
speak.  But  it  is  nowise  clear  that  this  gentleman's  early  ex- 
periences of  speech  were  totally  lost ;  they  might  have  been 
revived  in  some  dream  had  a  suitable  stimulus  chanced  to  occur. 
The  leading  experiences  of  our  early  days  are  certainly  often 
revived  in  dreams,  many  scenes  of  which  notably  testify  to  the 
memories  of  school  or  college  experience.  And  the  character  of 
the  scenes  into  which  the  materials,  whether  recent  or  old,  are 
worked  will  be  much  affected  by  the  character  of  the  individual 
dreamer,  who,  according  as  he  be  proud  or  humble,  aggressive  or 
retiring,  bold  or  timid,  sanguine  or  melancholic,  revengeful  or 
placable,  generous  or  mean,  candid  or  cunning,  will  not  fail  to 
find  himself  in  his  dreams.  In  this  influence  of  character  there 
may  be  said  to  be  a  reversion  to  ancestral  experiences  and  an 
awakening  of  their  substrata  to  activity;  for  a  person  who 
exhibits  a  trait  of  his  grandfather's  character  might  be  said  to 
repeat  or  remember  what  his  grandfather  felt. 

Besides  the  patent  and  direct  associations  which  are  easily 
traced,  there  are  indirect  and  subtle  ways,  not  easily  traced,  by 
which  a  suggestion  or  incident  of  the  day  may  revive  memories 
of  the  past.  A  sensation  which  has  been  associated  with  some 
mental  experience  of  a  long  time  ago — a  particular  sound,  for 
example,  or,  better  still,  a  particular  odour — will  sometimes 
bring  back  in  a  dream  the  conceptions  and  feelings  of  that  ex- 
perience, although  it  may  have  been  only  a  momentary  percep- 
tion, and  may  not  have  awakened  any  associations  in  the  day  ; 
and  a  particular  idea  or  a  particular  feeling  which  has  passed 
quickly  through  consciousness  as  a  transient  and  isolated  state 
will  do  the  same  thing.     I  get  a   momentary   whiff  of  some 


I.]  SLEEP  AND  DREAMING.  23 

peculiar  odour  as  I  pass  along  the  street,  and  I  dream  at  night 
of  scenes  of  boyhood  that  were  associated  with  that  odour,  but 
of  which  I  had  not  even  thought  in  the  day :  I  see  a  man  or 
hear  his  name  mentioned  in  the  day,  and  his  wife,  of  whom  I 
never  thouglit  in  the  least,  has  a  place  in  my  dream.  It  is 
probable  that  these  passing  hints  or  occasions  of  the  day  furnish 
much  of  the  explanation  of  the  apparently  mysterious  manner 
in  which,  with  nothing  that  we  can  conceive  to  evoke  their 
recurrence,  we  go  back  in  our  dreams  to  scenes  and  events  of 
an  early  period  of  our  lives.  Knowing  the  many  influences  to 
which  we  are  exposed  in  a  day,  some  of  them  scarcely  conscious, 
the  multitude  of  ideas  that  pass  through  the  mind,  the  variations 
of  feehng  which  we  undergo,  it  is  obvious  that  we  have  here 
the  possible  explanation  of  the  occurrence  of  many  dreams 
w^hich  perplex  us  mightily.  Hidden  and  unused  paths  of  asso- 
ciation are  hit  upon  and  pursued,  and  lead  to  the  recovery  of 
forgotten  experiences.  It  should  be  borne  in  mind  in  this  rela- 
tion that  an  idea,  when  excited  to  activity,  does  not  strike  one 
chord  of  association  only,  but  strikes  one  chord  predominantly, 
so  that  the  others  die  away  unperceived,  which  were  neverthe- 
less in  partial  vibration :  during  sleep  another  than  the  accus- 
tomed chord  may  respond  most  actively,  and  so  lead  to  the 
revival  of  less  familiar  associations  than  those  which  are  habitual 
in  the  wakinsr  state. 

iSTote  this  again  :  that  a  natural  feeling  occasioned  by  some 
scene  or  event  of  the  day  will  call  up  in  dreams  scenes  or  events 
of  the  past  which,  when  they  happened,  had  caused  a  similar 
feeling,  but  which  are  themselves  as  entirely  unconnected  with 
the  recent  event  as  they  are  distant  from  it  in  time.  For  ex- 
ample, some  unpleasant  occurrence  in  the  day  is  a  painful  rebuff 
to  our  self-love  and  excites  a  mingled  feeling  of  depression  and 
humiliation ;  the  sad  feeling,  lingering,  as  such  feelings  will,  as 
dull  depression  after  we  have  ceased  to  think  about  it,  persists 
through  sleep  and  is  translated  into  appropriate  imagery;  we 
thereupon  dream  of  our  school- days,  if  they  were  unhappy,  in 
which  we  underwent  similar  humiliations  of  feelino:,  combining^ 
perhaps  the  persons  and  incidents  of  those  days  with  the  persons 
and  incidents  of  the  event  which  has  affected  us  painfully.    The 


24  PATHOLOGY  OF  MIND.  [chap. 

allied  feeliug  has  called  up  an  almost  forgotten  train  of  sympa- 
thetic ideas,  and  we  are  not  a  little  astonished  even  in  our  dream 
to  find  our  adult  selves  in  such  a  painful  position  of  school-boy 
subordination.  In  like  manner  a  gay  feeling^  of  elation  occa- 
sioned by  some  flattering  experience  of  the  day  will  get  concrete 
interpretation  or  representation  in  suitable  dream-imagery. 

One  is  apt  to  think  that  the  images  and  events  of  a  distressing 
dream  are  the  causes  of  the  feeling  of  distress  which  is  expe- 
rienced, but  they  are  not  really  so  ;  the  feeling  is  more  truly 
the  cause  of  the  images ;  it  is,  so  to  speak,  the  mother-mood  of 
them.  A  well-known  habit  of  the  mind  is  to  seek  for  and  to 
create,  if  need  be,  with  or  without  distinct  consciousness,  an 
outward  object  as  the  cause  of  its  feelings  ;  if  there  be  no  objec- 
tive cause  of  them,  it  will  invest  some  indifferent  objects  with 
the  attributes  proper  to  produce  them,  or  will  altogether  create 
suitable  objects ;  and  this  tendency  is  forcibly  illustrated  in 
dreams  and  in  insanity.  Coleridge  has  aptly  remarked  that 
the  images  of  dreams  undergo  the  strangest  and  most  sudden 
metamorphoses  without  causing  much  or  any  surprise,  and  that 
they  disappear,  together  with  the  agonies  of  terror  accompanying 
them,  the  moment  we  awake  ;  which  would  not  be  the  case  if 
they  caused  the  terror  which  they  appear  to  do.  In  like  manner 
the  painful  delusions  of  one  who  is  suffering  from  that  form  of 
profound  mental  depression  which  is  known  as  melancliolia 
undergo  changes  sometimes^perhaps  from  terrible  to  grotesque 
— without  the  least  change  in  his  distress  ;  the  latter  indeed 
may  exist  for  some  time  as  a  vague  and  terrible  feeling  without 
any  definite  delusion,  and  it  is  a  matter  of  accident  rather  than 
of  the  essence  of  the  disease  what  shape  the  delusions  take.  In 
this  generation  or  crystallisation  of  the  images  of  fear  out  of 
the  troubled  feeling  we  perceive  a  demonstration  of  the  true 
nature  of  so-called  ghosts  and  apparitions :  they  are  the  effects 
or  exponents  of  the  feeling  of  expectant  apprehension  which  has 
been  engendered  by  reading  or  talking  or  thinking  about  them. 
Wlien  Luther  saw  the  Devil  enter  his  chamber  at  Wittenberg 
and  instantly  flung  the  inkstand  at  his  head,  he  seems  to  have 
been  neither  horrified  nor  greatly  surprised,  and  to  have  re- 
sented the  visit  rather  as  an  intrusion  which  he  had  expected 


I.]  SLEEP  AND  DREAMINa.  25 

from  an  adversary  with  whom  he  had  had  many  encounters  ; 
but  had  the  Devil  really  surprised  Luther  by  walking  into  his 
chamber,  I  doubt  whether  he  would  have  been  so  quick  and 
energetic  in  his  assault.  Those  who  see  ghosts  under  these 
circumstances  of  mental  preparation  do  not  suffer  much  in  con- 
sequence, though  they  may  protest  when  they  narrate  their 
story  that  their  hair  stood  on  end  and  that  they  were  in  an 
agony  of  fright ;  whereas  those  who  have  been  actually  scared  by 
a  sudden  apparition — by  a  figure  mischievously  dressed  up  as  a 
ghost,  for  example — have  often  suffered  seriously  from  the  shock, 
having  fainted  or  fallen  in  a  fit,  or  had  a  brain-fever  in  conse- 
quence, or  been  killed  outright  by  the  shock.  In  the  one  case 
the  apparition  was  to  a  mind  suitably  prepared  for  it  by  an 
antecedent  state  of  feeling,  and  gave  the  vague  feeling  form, 
wherefore  there  was  no  great  surprise ;  in  the  other  case  it  came 
unexpectedly  upon  a  mind  that  was  not  attuned  to  it,  therefore 
with  a  great  shock,  and  was  correspondingly  disastrous  in  its 
effects. 

It  would  be  a  long  task  to  deal  adequately  with  the  pheno- 
mena of  dreams,  and  a  book,  not  a  chapter,  would  be  necessary 
to  set  forth  the  results  of  a  full  inquiry.  I  shall  content  myself 
with  relating  a  dream  which  was  one  among  several  vivid  dreams 
that  followed  one  another  on  an  unresting  night  of  dreams,  in 
order  to  show  how  the  most  incongruous  circumstances  may,  if 
examined  with  sufficient  care,  be  traced  to  incidents  in  past 
experience.  I  was  in  a  large  building  crowded  with  people, 
which  was  partly  like  a  church  and  partly  like  a  public  hall, 
when  two  clergymen  who  somehow  became  three  walked  up  a 
middle  aisle  to  the  pulpit  which  stood  on  one  side  of  it,  two  of 
them  turning  aside  to  go  into  it,  and  the  third  continuing  his 
way  along  the  aisle  towards  the  place  where  the  altar  would 
stand ;  disappearing,  however,  mysteriously,  aisle  and  all,  after 
he  had  gone  some  way.  One  of  the  clergymen  was  deformed, 
being  bent  nearly  double,  and  the  pulpit,  as  soon  as  he  got  into 
it,  was  transformed  into  something  like  the  platform  of  a  public 
hall  with  seats  rising  in  rows  behind  it  and  crowded  with  people, 
at  the  end  of  one  of  which  I  stood.  One  of  the  clergymen 
began  the  service  or  the  proceedings  by   reading  an  opening 


26  PATHOLOGY  OF  MIND.  [chap. 

verse  which  I  was  a  little  surprised  not  to  recognise,  and  the 
other,  instead  of  going  on,  as  I  had  expected,  with  the  *'  Dearly- 
beloved  "  of  the  Prayer  Book,  went  on  to  read  a  tedious  story  from 
some  strange  book  until  I  was  wearied  ;  when  suddenly,  as  I  was 
wondering  to  myself  what  in  the  world  he  was  reading,  an  old 
man  in  the  body  of  the  church  or  hall  shouted  out,  "  Beautiful 
death  be  damned,  let  us  handle  life," — and  then  began  to  give 
out  a  hymn  like  a  parish  clerk  of  the  olden  time.  There  was  a 
general  start  of  amazement  throughout  the  congregation,  and  I 
turned  round,  and,  placing  one  hand  before  my  eyes,  laughed 
heartily  to  myself.  At  that  moment  a  German  friend  whom 
I  had  not  seen  for  years  stood  before  me,  and  I  awoke. 

Such  was   the   dream,  and  the   interpretation  of  it  was  as 
follows  : — The  hall  was  a  combination  of  the  old  parish  church 
which  I  used  to  attend  when  a  boy,  and  of  St.  James's  Hall, 
where  I  had  lately  been  at  a  crowded  public  meeting,  sitting  on 
that  occasion  behind  the  platform.     The  deformed  clergyman 
was  like  a  gentleman  whom  I  had  been  in  the  habit  of  seeing 
in  the  street  frequently,  ten  years  ago,  as  he  lived  next  door  to 
me,  and  whose  appearance  had  made  an  impression  upon  me. 
He  was  not  a  clergyman,  nor  had  he  the  least  connection  with 
any  event   of  my  life,  and  how  he  came  to  take  part   in  the 
dream  I  cannot  imagine.     The  long  story  which  he  began  to 
read  in  the  pulpit,  instead  of  the  j)roper  address  to  the  people, 
was  evidently  suggested  by  the  fact  that  I  had  read  that  day  in 
a  newspaper  a  paragraph  professing  to  give  an  account  of  Dr. 
Newman's  daily  life  at  the  Oratory,  Birmingham,  in  which  it 
was  told  that  while  the  brethren  of  the  Oratory  were  at  dinner 
one  of  them   read  aloud  the   life  of  some  saint  or  other  in- 
structive matter.     The  outburst  of  the  old  man  who  resembled 
in  manner,  though  not  in  face,  the  parish   clerk  of  my  early 
days,  was  derived  from  my  remembrance  of  a  well-known  passage 
from  Jean  Paul,  which  had  often  been  in  my  mind — "  Oh  !  how 
beautiful  is  death,  seeing  that  we  die  in  a  world  of  life   and 
creation  without  end  !  "  and  the  latter  part  of  his  exclamation 
was  clearly  suggested  by  the  familiar  lines  of  Tennyson  :— 

"  'Tis  life,  not  death,  for  which  we  pant, 
More  lifC;  and  fuller,  that  we  want." 


I.]  SLEEP  AND  DEEAMING.  27 

The  turning  round  and  laughing  to  myself  with  my  hand 
before  my  eyes  was  a  trick  of  my  German  friend  when  he  was 
amused  at  any  meeting  with  what  he  called  a  "  capital  humbug :  " 
my  repetition  of  his  movement  had  brought  before  me  the 
image  of  my  friend.  The  whole  dream  was  the  affair  of  an 
instant,  for  it  was  on  a  night  when  I  no  sooner  got  to  sleep  than 
I  began  dreaming  furiously  and  was  awakened  again.  A  few 
nights  afterwards  I  found  myself  in  a  dream  endeavouring 
eagerly  to  trace  the  associations  of  my  dream,  no  doubt  in 
consequence  of  the  particular  attention  which  I  had  been  lately 
giving  to  the  events  of  my  dreams  and  of  my  efforts  to  explain 
them. 

Under  the  heading  of  precedent  mental  experience,  albeit  not 
personal  experience,  one  might  class  instances  of  what  seem  to 
be  reversions  in  sleep  to  ancestral  modes  of  thought,  feeling,  and 
action.  Take,  for  example,  the  case  mentioned  by  Darwin, 
of  the  gentleman  who  used  to  make  a  peculiar  movement  of 
the  right  arm  when  fast  asleep,  raising  it  slowly  in  front  of  the 
face  and  then  letting  it  drop  heavily  on  the  nose,  and  whose  son 
and  granddaughter  made  exactly  the  same  movements  when 
they  were  sound  asleep.^  Here  nervous  substrata  stimulated  in 
sleep  gave  out  in  motor  function  what  had  been  embodied  in 
their  constitution  by  ancestral  experiences.  What  is  to  prevent  ^ 
a  materialised  mental  experience  being  aroused  in  the  same 
way  ?  Such  a  common  saying  as  that  "  It  is  his  father's  trick 
all  over  "  may  be  as  true  of  mind  as  of  body,  and  as  true  of  the 
dreaming  as  of  the  waking  mind. 

I  pass  on  now  to  consider  the  second  class  of  dream  stimuli. 
I  haA*e  said  enough  to  show  that  the  least  occasions  in  the  day 
may  lead  to  the  revival  of  experiences  that  have  long  lain  in 
oblivion,  and  to  their  employment  in  the  strangest  and  most 
novel  dramatic  constructions,  and  to  prove  also  that  the  combin-  \i 
ing  and  creative  power  which  lies  at  the  root  of  what  we  call 
imagination  is  something  which  is    spontaneous   in    character, 

1  Darwin  on  The  Expression  of  the  Emotions  in  Man  and  Animals.  See  * 
also  a  suggestive  paper  on  "Some  Organic  Laws  of  Memory,"  by  Dr.  ^ 
Laycock,  in  Jouimal  of  Mental  Science^  Ju^^  1875. 


28  PATHOLOGY  OF  MIND.  [cuap. 

instantaneous  almost  in  its  operations,  and  even  more  inventive 
in  sleep  than  during  waking. 

2.  hninessions  on  a  Special  Sense. — Inasmuch  as  the  senses 
are  not  always  equally  deeply  asleep  when  we  are  asleep,  one  or 
other  of  them  is  sometimes  so  far  awake  as  to  be  susceptible 
to  impressions ;  and  it  is  certain  that  such  impressions  may  be 
the  occasion  or  determine  the  character  of  a  dream.  Dr. 
Gregory  tells  how,  having  gone  to  sleep  with  a  bottle  of  hot 
water  at  his  feet,  he  dreamt  that  he  was  walking  up  the  crater 
of  Mount  Etna.  Though  he  had  never  visited  Etna,  at  an  earlier 
period  of  his  life  he  had  ascended  Vesuvius,  and  had  felt  a 
sensation  of  warmth  in  his  feet  when  walking  up  the  side  of 
the  crater.  The  sensation  of  warmth  in  his  feet  was  the  evident 
cause  of  the  peculiar  character  of  his  dream.  There  is  an  often 
quoted  story  of  a  person  who,  having  had  a  blister  applied  to 
his  shaven  scalp,  dreamed  that  he  was  being  scalped  by  Eed 
Indians.  A  sound  in  the  room  or  outside  it  which  actually 
awakens  the  sleeper  may  occasion  or  take  part  in  a  dream 
which  seems  to  have  occupied  a  considerable  time,  but  which 
must  have  been  over  in  an  instant :  the  sound  is  heard  before 
he  is  actually  conscious,  and  the  mind,  hastening  to  give  some 
interpretation  of  it,  calls  up  probably  such  ideas  as  have  been 
associated  with  a  strong  or  recent  impression  upon  the  waking 
mind.^  Alfred  Maury  carried  through  a  series  of  experiments 
upon  himself  in  order  to  test  the  influence  of  impressions  made 
upon    him  when  he  was  asleep.     He   instructed  a   person   to 

'  The  cerebral  reception  and  assimilation  of  an  impression  prior  to 
conscious  knowledge,  which,  when  it  comes  immediately  afterwards,  is 
perforce  struck  by  it  as  an  exactly  similar  former  experience  (see  Phy- 
siology of  Mi7id,  p.  33),  is  a  phenomenon  of  the  same  kind.  In  some 
morbid  states  of  the  brain  these  illusions  of  former  identical  experiences 
are  very  marked.  In  the  Archiv  fur  Psychiatrie  Dr.  Pick  records  the 
case  of  an  insane  patient  sent  to  an  asylum  in  consequence  of  excite- 
ment and  delusions  that  people  put  poison  in  his  food,  listened  to  his  con- 
versation, &c.  "From  his  early  years  he  had  a  vague  consciousness  as  if 
the  events  he  was  passing  through  had  been  already  experienced.  At  first 
these  notions  were  of  a  dim  and  uncertain  character,  but  in  the  course  of 
time  they  got  clearer,  so  that  he  thought  he  possessed  a  double  nature. 
.  .  .  Visits  to  pleasure  resorts,  the  sight  of  public  amusements,  and  casual 
interviews  with  persons  so  affected  his  memory  that  he  was  convinced 
he  had  already  visited  the  same  places  and  seen  the  same  persons  under 
exactly  the  same  circumstances."     (Bd.  vi.,  H.  2,  p.  568). 


I.]  SLEEP  AND  DREAMING.  29 

remaiu  by  liis  side  and  to  make  various  impressions  upon  his 
senses,  without  telling  him  beforehand  what  he  was  going  to  do, 
and  to  awaken  him  soon  after  each  impression.  His  lips  and  the 
end  of  his  nose  being  tickled  with  a  feather,  he  dreamed  that  a 
pitch  plaster  had  been  applied  to  his  face  and  afterwards  torn 
away  so  violently  as  to  bring  with  it  the  skin  of  his  lips,  nose, 
and  face.  AVhen  he  was  pinched  at  the  back  of  the  neck,  he 
dreamed  that  a  blister  was  applied  to  his  neck  ;  and  that 
brought  to  his  mind  a  doctor  who  had  treated  him  in  his  infancy. 
Other  experiments  had  similar  results,  but  in  many  of  them 
there  was  no  connection  to  be  traced  between  the  stimulus  and 
the  dream.  Most  persons  must  have  dreamed  at  one  time  or 
another  that  they  were  going  about  in  the  street  naked  and  have 
felt  embarrassed  or  distressed  at  their  unfortunate  predicament : 
it  is  probable  that  the  occasion  of  this  dream  is  a  sensation  of 
cold  arising  perhaps  from  an  insufficiency  of  clothing  or  from 
the  clothes  having  fallen  off  the  bed  so  as  to  partially  expose 
the  body.  Were  the  sleeper  in  a  feverish  state  a  feeling  of 
chill  might  induce  the  dream  without  any  insufficiency  or  dis- 
arrangement of  the  clothes.  When  fever  or  other  bodily 
disturbance,  such  as  indigestion,  has  produced  irritation  or  a 
disordered  sensibility  of  the  skin,  as  it  will  do,  it  is  easy  to 
understand  that  impressions  upon  it  will  be  perverted  and  wOl 
be  likely  when  they  reach  the  brain  and  are  translated  there 
into  objective  forms  to  undergo  extraordinary  transformations  : 
the  least  touch  may  become  a  blow,  or  a  stab,  or  a  bite  from  some 
savage  monster,  causing  the  sleeper  to  wake  up  in  the  fright  of 
a  nightmare. 

Coleridge  was  of  opinion  that  the  nightmare  was  not  a  mere 
dream,  but  that  it  always  occurred  just  when  the  waking  state 
of  the  brain  was  recommencing,  "  and  most  often  during  a  rapid 
alternation,  a  twinkling,  as  it  were,  of  sleeping  and  waldng."  He 
supposed,  in  fact,  that  actual  impressions  from  without  enter 
into  and  mingle  with  the  dream  images  in  such  case  and  give 
them  an  air  of  greater  reality ;  for  there  is  at  the  moment  a 
complete  loss  of  power  to  distinguish  between  the  subjective 
images  and  the  objective  realities.  Without  doubt  this  is  what 
happens  sometimes,  but  whether  always  so  is  not  certain.     It  is 


BO  PATHOLOGY  OF  MIND.  [chap. 

worthy  of  note,  however,  that  in  that  form  of  melancholia  in 
which  the  insane  person's  mind  is  possessed  with  some  vague, 
vast,  and  horrible  delusion,  and  he  is  incapable  of  the  least  exer- 
tion, standing  or  sitting  like  a  statue  wherever  he  may  be  placed 
— in  which  he  maybe  truly  said  to  be  in  a  state  of  lasting  night- 
mare— impressions  from  without  that  are  received  by  the  senses 
are  perverted  to  suit  the  horrors  of  the  delusions.  The  patient 
has  no  power  to  distinguish  between  the  subjective  feelings  arising 
out  of  his  morbid  state  and  the  actual  impressions  made  upon 
his  senses  ;  and  the  anxious  efforts  of  friends  to  rouse  him  from 
his  fearful  lethargy,  to  comfort  him  with  kindly  assurances,  to 
sustain  him  with  suitable  nourishment  which  he  refuses,  appear 
to  be  the  malignant  jeerings  and  tortures  of  devils  by  whom  he 
is  surrounded  and  tormented.  In  less  extreme  cases  of  mental 
derangement,  the  misinterpretation  of  actual  sensations  is 
common  enough  :  a  perverted  sensation  of  taste,  which  may  be 
the  outcome  of  digestive  disorder,  originates  or  strengthens  a 
delusion  in  the  morbid  mind  that  poisonous  substances  have 
been  pat  into  the  food ;  a  perverted  smell  is  thought  to  be  pro- 
duced by  noxious  vapours  disseminated  through  the  air;  a 
disordered  touch  suggests  the  play  of  mysterious  magnetic  in- 
fluences. Moreover,  once  the  delusive  interpretation  has  been 
made  it  reacts  upon  sense  and  aggravates  the  disordered  sensa- 
tion, just  as  the  expectation  of  a  particular  sensation  being 
about  to  be  felt  sharpens  the  sense  to  feel  it.  These  points  of 
resemblance  between  the  operations  of  the  mind  in  dreaming 
and  in  insanity  are  of  much  interest,  as  shedding  light  upon 
each  other's  phenomena ;  for  if  we  could  get  at  the  actual  con- 
ditions of  the  former  it  is  certain  we  should  have  a  valuable 
clue  to  guide  our  inquiries  into  the  darker  recesses  of  the 
latter. 

3.  Organic  or  Systemic  Imi^ressions. — There  are  particular 
dreams  which  I  have  from  time  to  time,  and  which  I  feel  sure 
originate  in  certain  states  of  the  abdominal  viscera.  I  take  it 
for  granted  here  that  each  internal  organ  of  the  body  has, 
independently  of  its  indirect  action  upon  the  nervous  system 
through  changes  in  the  composition  of  the  blood,  a  specific 
action  upon  the  brain  through  its  intercommunicating  nerve- 


1.]  SLEEP  AND  DREAMING.  31 

fibres,  the  conscious  result  whereof  is  a  certain  modification  of 
the  mood  or  tone  of  mind.  We  are  not  directly  conscious  of 
this  physiological  action  as  a  definite  sensation,  but  none  the 
less  its  effects  are  attested  by  states  of  feeling  that  we  are  often 
perplexed  to  account  for.  In  truth  these  organic  effects  of  the 
physiological  consensus  of  organs  determine  at  bottom  the  play 
of  the  affective  nature ;  its  tone  is  the  harmonic  or  discordant 
outcome  of  their  complex  interactions ;  the  strength  of  the  force 
which  we  develop  as  will  and  the  emotional  colour  in  Avhich  we 
see  life  have  their  foundation  in  them.  This  being  so,  it  is 
evident  that  when  the  external  senses  are  shut  in  sleep  and  the 
conscious  operations  of  mind  in  abeyance,  these  internal  effects 
wall  be  likely  to  declare  themselves  more  distinctly,  as  the  stars 
come  forth  brightly  when  the  sun  goes  doAvn  and  they  are  no 
longer  veiled  by  his  greater  light.  The  sympathetic  mood  or 
feeling  aroused  by  a  particular  organ,  which  may  from  some 
cause  in  itself  be  exerting  a  more  active  influence  upon  the 
brain  than  is  usual  in  sleep,  will  call  into  activity  the  sympa- 
thetic ideas  of  that  mood,  furnishing  the  background  on  w^hich 
the  appropriate  dream  imagery  is  thrown ;  it  will  determine  not 
the  specific  forms  of  the  ideas  directly,  but  the  ground-tone, 
whether  exalted  or  depressed,  of  the  drama  which  they  con- 
struct— that  is,  tlie  character  of  the  dream  in  relation  to  the 
personality. 

It  will  not  be  disputed  that  we  rightly  discover  in  these 
operations  the  occasions  of  many  dreams  ;  for  there  are  manifold 
undefined  changes  in  our  systemic  feeling  which  may  well  have 
their  different  effects  in  dreams,  though  we  cannot  distinguish 
and  describe  them  when  we  are  awake.  When  the  breathino-  is 
not  free  enough  in  sleep,  and  the  heart's  action  is  oppressed,  as 
it  eventually  is  in  such  case,  the  sleeper  is  apt  to  wake  up 
suddenly  in  the  greatest  apprehension  of  something  terrible 
being  about  to  be  done  to  him  in  his  dream.  The  natural  and 
involuntary  motor  expression  of  an  oppressed  heart  is  such 
action  of  the  muscles  of  the  face  and  of  respiration  as  betokens 
fear  and  apprehension;  but  this  action  cannot  take  place  in 
sleep,  and  in  its  stead  we  get  an  equally  involuntary  expression 
of  the  physical  state  in  the  terrifying  dream  and  in  the  frantic 


32  PATHOLOGY  OF  MIND.  [chap. 

but  bootless  desire  wliicli  is  felt  to  escape  from  the  threatened 
danger.     For  when  a  passion  has  l)een  aroused,  or  rather  when 
that  excitation  of  the  nervous  substrata  which  are  its  physio- 
logical basis  has  been  brought  about,  the  energy  may  be  expended 
in  one  of  two  principal  w^ays  :  either  by  putting  in  action  the 
muscles   which   are  its  natural   exponents,   or   by    calling   up 
related   or   sympathetic    ideas   and    putting   them   in   action. 
Now  if  a  person  has  fairly  sound  sleep  I  conclude  that  his 
motor   nerve   centres  and  his  muscular  system   are  so  much 
asleep  that  he  cannot  make  use  of   them  to  give  expression 
to  his  internal  state  in  its  appropriate  movements,  and  that  the 
energy  of  it  is  expended  mainly  in  the  painful  dream  imagery. 
There  is  a  sort  of  inverse  relation  between  ideas  and  movements 
in  regard   to  their  action  :   when   we   are  deeply  absorbed  in 
thought  the  body  is  still  and  respiration  is  slower  ;  when  we  are 
active  and  are  breathing  quickly  we  cannot  think ;  the  insane 
person  whose  mind  is    possessed  with  some  vast  and  fearful 
delusion  is  passive  or  statuesque ;  and  the  ecstatic,  when  rapt 
in  contemplation,  is  motionless,  with  scarcely  perceptible  pulse 
and  respiration  ;  the  passion  that  has  outlet  in  abusive  speech  or 
in  other  movements  disturbs  not  much  the  thoughts  ;  the  anger 
which  is  suppressed  calls  up  a  host  of  malignant  ideas.     In  like 
manner  the  partially  active  cerebral  state  excited  by  one  of  the 
viscera  in  sleep  becomes  the  occasion  of  a  dream,  when  it  would 
probably  be  discharged  during   waking  in  such  simple  bodily 
movements    as  yawning,   or  stretching  the  limbs,  or  the  like. 
For  there  are  a  great  many  seemingly  purposeless  movements  of 
that  kind  that  are  made  constantly  by  us,  and  hardly  noticed 
when  we  are  awake,  the  stimuli  of  which  come  from  the  organic 
life.     Some  such  movements  as  moving  the  arms,  stretching  out 
the  legs,  turning  the  body,  we  do  make  when  we  are  asleep,  but 
on  the  whole  ideas  are  then  much  more  active  than  movements. 
A  heavy  and  indigestible  meal  taken  a  short  time  defore  going 
to  bed  is  a  well-known  cause  of  a  form  of  nightmare  in  which 
the  person  dreams  that  he  has  a  mountain  or  a  monster  lying 
upon  his  chest  and  crushing  it  by  its  weight.     "Whether  the 
dream   be   the  direct  effect  of  the   action   of  the  overloaded 
stomach  upon  the  brain  or  an  indirect  effect  of  the  oppression 


1.]  SLEEP  AND  DREAMING.  33 

of  the  functions  of  the  lungs  and  of  the  lieart  is  not  easy  to  say, 
but,  whatever  the  actual  mode  of  operation,  it  is  interesting  to 
note  how  well  the  mental  interpretation  of  the  oppression  suits 
with  the  cause.  The  troubles  of  indigestion  seldom  fail  to  cause 
a  dreaming  sleep.  Whether  the  spleen  ever  gives  a  specific  colour 
to  a  dream  is  quite  uncertain,  but  there  can  be  no  doubt  that 
disorders  of  the  liver  and  of  the  intestines  both  occasion  dreams 
and  affect  their  character.  Every  stage  of  the  passage  of  food 
til  rough  the  alimentary  canal  may  indeed  affect  the  impression 
made  upon  the  brain,  and  the  impression  is  thereupon  interpreted, 
as  other  feelings  of  subjective  origin  are,  in  accordance  with  the 
objective  experiences  of  the  senses.  I  have  several  times  had  a 
vivid  dream  that  I  was  engaged  in  conducting  a  post-mortem 
examination  of  a  body  which  came  to  life  and  quietly  rose  up 
to  a  sitting  posture  on  the  table  as  I  was  at  work.  On  one 
occasion  I  seized  a  wooden  mallet  and  struck  it  on  the  head 
with  all  my  might ;  on  another  occasion  I  thrust  my  hand 
into  the  oj^en  chest  and  tore  out  the  heart ;  but  neither 
of  these  desperate  deeds  seemed  to  make  it  die  and  behave 
as  a  corpse  should.  On  all  occasions,  so  far  as  I  remember, 
there  was  the  same  indescribable  feeling  of  puzzled  surprise 
and  apprehension,  with  a  resolution  to  -escape  at  any  cost 
the  consequences  of  cutting  up  a  living  body ;  there  was 
moreover  a  strong  sense  of  personal  repression  or  humiliation 
which  I  have  never  had  in  actual  life  since  I  was  at  schooL 
This  dream  seems  always  to  have  occurred  in  connection  with 
some  uncomfortable  intestinal  state  :  not  that  this  had  anything 
to  do  with  the  special  incidents  of  the  dream,  but  it  probably 
had  much  to  do  with  the  fundamental  feeling  of  self-repression 
which  inspired  it.  I  am  acquainted  with  an  eminent  gentleman 
who,  when  he  is  suffering  from  a  certain  abdominal  trouble, 
dreams  that  he  is  going  in  distress  from  water-closet  to  water- 
closet  at  a  railway  station  to  find  them  all  occupied  or  in  such  a 
condition  as  to  be  unfit  for  use.  There  is  an  indirect  way, 
moreover,  in  which  abdominal  derangements  help  to  affect 
mental  states  in  sleep — namely,  through  the  effect  which  they 
produce  upon  the  skin.  When  there  is  irritation  or  other 
disorder  of  the  mucous  membrane  of  the  stomach  and  intestines 


34  PATHOLOGY  OF  MIND.  [chap. 

the  outer  covering  of  the  body,  with  which  it  is  really  con- 
tinuous, sympathises  and  becomes  irritable  and  has  its  sensibility 
affected,  on  which  account  the  meaning  of  impressions  made 
upon  it  is  more  than  usually  perverted  in  dreams. 

The  internal  organs  which  show  their  specific  effects  upon  the 
mind  most  plainly  are  the  reproductive  organs ;  the  dreams 
which  they  occasion  are  of  such  a  character  as  leaves  no  doubt 
of  the  specific  character  of  the  stimulus.  Without  entering 
into  a  detailed  discussion  of  their  phenomena,  I  may  deduce 
briefly  from  their  striking  character  certain  lessons  which  are 
not  so  plainly  tanght  by  the  more  obscure  effects  of  other 
internal  organs.  In  the  first  place,  it  is  a  probable  inference 
from  their  characteristic  effects  that  specific,  though  less  striking, 
effects  are  produced  by  other  organs.  Secondly,  it  may  be  noted 
that  these  characteristic  dreams,  which  appear  for  the  first  time 
when  the  reproductive  organs  begin  to  function,  occur  to  the 
individual  before  there  has  been  any  actual  experience  of  the 
exercise  of  these  functions  or  any  observation  of  their  exercise. 
The  experience  is  in  entire  accordance  with  the  fact  that  there 
is  no  need  ever  to  teach  young  persons  how  to  exercise  the 
functions ;  the  instinct  giveth  the  understanding  necessary  for 
its  gratification.  Clearly  there  are  nervous  substrata  that  are  in- 
active in  every  person's  brain  until  he  reaches  puberty  and  which 
then  function  for  the  first  time.  This  might  teach  us  to  consider 
how  many  peculiarities  of  thought,  feeling,  and  behaviour  which 
differentiate  us  from  other  persons  are  due  to  nervous  substrata 
inherited  from  near  or  remote  ancestors,  some  of  which  come 
into  functional  action  perhaps  in  connection  with  particular 
bodily  changes  that  occur  at  certain  periods  of  life.  The 
individual  who  begins  to  feel,  think,  and  act  in  accordance  with 
his  kind  when  the  revolution  of  disposition  takes  place  at 
puberty  may  also  develop  for  the  first  time  peculiarities  of 
thought  and  feeling  which  his  forefathers  have  shown,  when, 
later  in  life,  the  functions  of  the  reproductive  organs  wane  or 
cease.  Lastly,  the  mental  operations  of  these  organs  serve 
to  show  of  what  character  the  effects  produced  by  internal 
organs  actually  are,  and  for  what  factors  in  mind  we  are 
indebted  to  them.     They  engender  a  particular  tone  or  feeling 


I.]  SLEEP  AND  DREAMING.  35 

of  mind  which  is  conducive  to  the  origin  and  activity  of 
certain  related  ideas,  and  they  impart  the  force  of  desire  by 
which  conduct  is  inspired;  but  they  do  not,  as  some  have 
supposed,  directly  affect  the  understanding,  which  is  a  function 
of  the  animal  life  or  life  of  relation,  and  is  developed  out  of 
sensations  and  motor  reactions  thereto, — that  is,  out  of  the 
capacity  to  receive  impressions  from  without  and  to  make 
responsive  adaptations  to  them.  The  office  of  the  intellect  is  to 
guide  and  direct,  steersman-like,  the  force  of  individuality  O 
which  is  derived  actually  from  the  unconscious  depths  of  the 
organic  life ;  the  sympathetic  ideas  which  a  particular  mood  of 
feeling  stirs  are  the  appropriate  channels  or  forms  in  which  that 
feeling  gets  expression  when  it  is  not  translated  instantly  into 
action ;  and  it  will  depend  much  upon  the  education  of  a 
person  in  youth,  and  by  the  experiences  of  life,  whether  the 
ideational  activities  shall  be  wise  or  unwise  expressions  of  the 
fundamental  feeling. 

I  have  said  enough  to  indicate  how  much  the  physiological 
action  of  the  visceral  organs  has  to  do  with  the  excitation  and 
with  the  character  of  dreaming.  On  the  whole  it  is  probable 
that  they  are  the  most  active  agents  in  this  respect ;  for  the 
sleep  of  the  body  is  not  their  sleep ;  they  continue  their 
functions  through  the  night,  albeit  at  a  lower  rate  of  activity; 
and  if  the  sleep  be  light,  or  if  one  or  more  of  their  functions  be 
so  far  deranged  as  to  become  an  unusual  stimulus,  their  cerebral 
sympathies  will  declare  themselves  in  the  irregular  activities  of 
dreams,  when  they  are  not  so  energetic  as  to  cause  waking. 

4.  Muscular  Sensibility. — It  is  related  of  several  holy  persons 
of  old,  men  and  women,  that  in  their  spiritual  raptures  or 
ecstasies  they  rose  bodily  from  the  earth  and  floated  in  the  air  ; 
and  there  can  be  small  doubt  that  some  of  them  felt  and  believed 
that  they  did.  St.  Philip  Neri,  St.  Dunstan,  St.  Christina  could 
hardly  be  held  down  by  their  friends,  while  it  is  told  of  Agnes 
of  Bohemia  that,  when  walking  in  the  garden  one  day,  she  was 
suddenly  raised  from  the  ground  and  disappeared  from  sight  of 
her  companions,  making  no  answer  to  their  anxious  inquiries 
but  a  sweet  and  amiable  smile  on  her  return  to  earth  after  her 
flight.      Everybody  must  at  one  time  or  another  have  had  a 


36  PATHOLOGY  OF  MIND.  [chap. 

similar  experience  in  his  dreams.  The  explanation  is  not  far  to 
seek  :  a  person  may  have  a  motor  hallucination,  so  to  speak,  and 
imagine  he  makes  the  movement  which  he  does  not,  just  as  he 
may  have  a  sensory  hallucination  and  imagine  he  sees  or  hears 
the  thing  which  he  does  not.  We  are  the  victims  of  motor 
hallucinations  when  we  suffer  from  what  is  called  vertigo  and  the 
room  seems  to  turn  round ;  the  intuitions  of  movements  which  we 
get  from  the  disordered  action  of  the  motor  centres,  and  which 
therefore  are  entirely  subjective,  are  interpreted  objectively  in 
accordance  with  our  ordinary  sensory  experience,  just  as  sensa- 
tions of  subjective  origin  are  interpreted  objectively,  and  so 
become  hallucinations.  Certain  drugs  when  taken  into  the 
blood  produce  vertigo  at  an  early  stage,  and  perhaps  convulsions 
at  a  later  stage  of  their  operation ;  they  affect  the  motor  and 
associated  sensory  centres  moderately  in  the  first  instance, 
exciting  them  to  a  disordered  activity,  the  subjective  aspect 
of  which  is  vertigo,  and  afterwards  more  severely,  when  the 
disordered  energy  is  discharged  in  actual  convulsions.  The 
drunken  person  when  he  shuts  his  eyes  feels  the  bed  to  sink 
under  him,  the  disorder  of  his  motor  intuition  being  interpreted 
objectively  in  that  way,  and  when  he  falls  on  the  ground  or 
runs  his  head  against  the  wall  he  perceives  the  ground  to  rise 
and  strike  him,  or  the  wall  to  run  forward  against  his  head : 
his  motor  troubles  and  hallucinations  are  the  direct  consequences 
of  the  poisoning  of  his  nervous  centres  by  alcohol.  One  of  the 
effects  of  aconite,  when  taken  in  poisonous  doses,  is  to  produce 
a  feeling  as  if  the  body  were  enlarged  or  were  in  the  air,  mainly 
perhaps  in  this  instance  because  of  the  loss  of  sensibility  of  the 
surface  of  the  body  which  is  an  effect  of  the  poison,  whereby 
the  person  does  not  feel  himself  in  contact  with  what  is  outside 
him  ;  the  part  of  the  body  from  which  he  gets  no  message  when 
it  is  touched  appears  therefore  to  be  no  longer  his,  and  he 
interprets  the  interruption  of  feeling  between  him  and  the 
outside  objects  as  an  actual  separation  of  substances  such  as 
would  be  produced  by  the  body  being  in  the  air.  These 
examples  will  serve  to  indicate  how  considerable  a  part  motor 
hallucinations,  combined  as  they  commonly  are  with  sensory 
disturbances,  may  play  in  the  phenomena  of  dreaming. 


1.]  SLEEP  AND  DKEAMING.  37 

An  uncomfortable  position  in  wliicli  the  sleeper  may  chance 
to  lie  becomes  the  occasion  sometimes  of  a  dream  that  he  is 
engaged  in  a  desperate  struggle,  or  is  clambering  for  very 
life  up  a  steep  precipice,  and  when  he  has  made  the  convulsive 
effort  to  save  himself,  which  he  feels  that  he  cannot  probably 
do  on  the  instant,  he  awakes  and  relieves  the  constrained  attitude. 
A  not  uncommon  dream  is  that  he  is  in  imminent  danger  of 
falling  from  a  height,  and  he  awakes  just  as  he  makes  the 
frantic  effort  to  prevent  himself  from  falling.  It  has  been  sur- 
mised that  this  dream  is  owing  to  the  gradual  relaxation  of 
the  muscles  as  he  goes  to  sleep  and  to  an  ensuing  sudden 
contraction  of  them,  such  as  we  observe  to  happen  when  a 
person's  head  who  is  very  sleepy  sinks  gently  forwards  as  the 
muscles  relax,  and  then  is  pulled  suddenly  up  with  a  jerk  by 
their  contraction ;  or  it  may  be  owing  to  the  inclined  position 
of  the  bed  on  which  the  body  is  lying.  After  great  muscular 
exertion  in  climbing  his^h  mountains  I  have  often  dreamed  of 
sliding  down  precipices,  falling  into  chasms,  and  the  like,  and 
that  so  vividly  sometimes  as  to  be  obliged,  on  waking,  to  stretch 
out  my  hands  and  grasp  the  sides  of  my  bed  before  I  could  feel 
sure  where  I  was ;  without  doubt  the  wearied  muscles  were  the 
occasion,  through  their  motor  centres,  of  the  mental  drama  in 
which  the  sensory  experiences  of  the  day  were  worked  up.  But 
I  was  once  surprised  to  dream  this  sort  of  dream  when  I  had 
been  making  no  particular  muscular  exertion  in  the  day,  nor 
had  been  near  any  mountains,  and  when  I  could  at  first  think 
of  nothing  which  could  have  provoked  it ;  on  reflection,  however, 
I  called  to  mind  a  momentary  experience  of  the  day  which 
seemed  to  be  a  sufficient  cause  ;  for  I  had  been  driven  rapidly 
in  a  waggonette  to  a  railway  station  in  the  country,  and  as  the 
horses  turned  a  corner  of  the  road  as  we  went  downhill,  my 
muscles  contracted  involuntarily  because  I  felt  from  the  swing 
of  the  carriage  a  necessity  to  hold  on  to  the  seat.  There  could 
be  no  doubt  that  this  momentary  feeling  of  a  support  failing 
was  the  occasion  of  the  night's  dream.  When  Braid  roused  in 
the  minds  of  persons  whom  he  had  put  into  the  hypnotic  sleep 
ideas  associated  with  certain  bodily  attitudes  by  putting  the 
body  into  the  proper  attitudes,  he  stimulated  the  mental  states 


38  PATHOLOGY  OF  MIND.  [chap. 

through  their  suitable  muscular  acts  ;  he  might  no  doubt  have 
excited  them  equally  successfully  without  any  muscular  action  by 
suitable  stimulation,  had  it  been  possible,  of  the  motor  centres 
only ;  exciting  in  this  way  the  motor  intuitions  without  the 
actual  movements,  just  as  is  done  when  delusive  notions  as  to 
different  positions  of  an  amputated  limb  are  excited  by  stimu- 
lation of  its  nerves.  There  can  be  little  doubt  that  what  Mr. 
Braid  did  experimentally  in  artificial  sleep  is  a  common  occur- 
rence in  natural  sleep,  and  ought  to  be  taken  account  of  in 
prosecuting  inquiries  into  the  causation  of  dreaming. 

It  may  be  interesting  to  speculate  whether  the  movements  of 
the  heart  and  of  respiration,  which  go  on  without  intermission, 
and  with  only  some  abatement  of  energy,  during  sleep,  have 
any  effect  upon -dreams.  That  they  have  no  such  effect  when 
they  are  not  accelerated  or  retarded  is  proved  by  the  fact, 
if  it  be  a  fact,  that  sleep  is  sometimes  dreamless ;  but  there  is 
good  reason  to  think  that  when  they  are  disordered  they  testify 
of  themselves  in  dreams.  On  several  occasions  I  have  had  a 
dream  in  which  I  felt  it  urgently  necessary  to  make  an  instant 
exertion  in  order  to  go  on  living,  having  experienced  a  vivid 
and  urgent  feeling  that  if  I  did  not  make  it  I  should  die  ;  and 
although  I  have  resolved  after  such  a  dream  to  remain  quite 
still  when  next  I  had  it,  in  order  to  test  what  would  happen,  I 
have  never  yet  succeeded ;  so  overwhelming  is  the  apprehen- 
sion at  the  time,  that  the  necessary  convulsive  start  or  gasp  has 
always  been  made,  and  I  have  awoke  in  a  state  of  agitation 
with  my  heart  beating  tumultuously.  The  dream  seems  to  have 
its  origin  in  an  impeded  action  of  the  heart,  which,  after  en- 
during the  oppression  for  a  while,  makes  a  violent  beat  to  recover 
itself,  and  then  goes  on  beating  rapidly  for  a  time.  It  may  be 
presumed  that  a  more  rapid  action  of  the  lungs  and  of  the  heart 
than  usual,  or  the  ordinary  action  of  these  organs  perhaps  under 
some  circumstances,  will  be  felt  by  the  brain  during  sleep,  and 
so  give  a  character  to  the  ensuing  dream.  What  this  character 
is  I  am  not  able  to  say,  unless  there  is  truth  in  the  conjecture 
that  the  sensation  of  flying  in  dreams  is  owing  to  a  consciousness 
of  the  rhythmical  activity  of  the  lungs  or  of  the  respiratory 
movements,  which  suggests  the  rhythm  of  flying  movements; 


I.]  SLEEP  AND  DREAMING.  30 

but  that  we  Lave  in  these  continuing  movements  occasional 
factors  in  the  production  of  dreams  is  in  accordance  with  general 
physiological  considerations,  and  with  such  positive  experience 
as  we  can  appeal  to  in  so  very  obscure  a  matter. 

5.  The  Cerebrcd  Circulation. — When  the  brain  is  thinking 
there  is  a  more  active  flow  of  blood  through  it  than  when  it  is 
at  rest ;  but  this  flow  must  not  be  too  active,  or  sound  thinking 
cannot  be  done.  There  are  two  conditions  which  experience 
proves  to  be  adverse  to  successful  thought — namely,  an  excessive 
and  a  deficient  flow  of  blood  through  the  brain.  There  may  be 
an  excess  of  blood  in  the  brain,  however,  with  a  retarded  circu- 
lation, a  passive  congestion,  which  equally  hampers  thought,  as 
it  prevents  the  free  outflow  of  vitiated  blood  and  the  free  inflow 
of  fresh  blood.  When  the  circulation  is  too  active  the  ideas  are 
rapid,  imperfect,  transitory,  tumultuous,  confused,  and  scarcely 
coherent ;  and  if  the  physical  disturbance  be  carried  a  step 
further,  the  tumult  of  ideas  degenerates  into  actual  delirium,  as 
we  plainly  observe,  for  example,  when  the  membranes  of  the 
brain  are  inflamed.  When  there  is  too  little  blood  or  impover- 
ished blood  flowing  tlirough  the  brain,  thought  is  also  impeded  : 
there  is  languor,  apathy,  incapacity  of  concentration  of  attention, 
positive  inability  to  think ;  and  if  the  condition  of  physical  dis- 
turbance be  aggravated,  then  also  there  is  delirium,  though  of  a 
looser,  more  feeble,  and  less  energetic  kind  than  the  delirium 
of  hypersemia.  Applying  these  considerations  to  the  state  of  the 
cerebral  circulation  in  sleep,  it  is  easy  to  understand  that  fluc- 
tuations of  it  will  oftentimes  be  the  occasion  of  dreams.  Notably 
these  are  sometimes  very  vivid  and  coherent ;  the  sleeper  awakes 
perhaps  out  of  a  dream  which  seemed  very  real,  goes  to  sleep 
again,  and  is  immediately  engaged  in  another  equally  vivid, 
which  leads  to  his  waking  again ;  no  sooner  is  he  asleep  once 
more  than  he  is  in  the  middle  of  another  vivid  dream,  and  as 
dream  thus  follows  dream  in  quick  succession,  making  a  curse 
of  slumber,  he  mie^ht  well  exclaim  in  the  words  of  Job — "  When 
I  say,  my  bed  shall  comfort  me,  my  couch  shall  ease  my  com- 
plaint ;  then  thou  scarest  me  with  dreams,  and  terrifiest  me 
through  visions." 

Tt  is  a  probable  conjecture  that  these  vivid  and  coherent 
3 


40  PATHOLOGY  OF  MIND.  [chap. 

dreams  mark  a  general  activity  of  the  cerebral  circulation, 
and  that  they  follow  one  another  as  long  as  it  continues. 
The  misfortune  is  that  in  this  condition  cause  and  effect 
seem  to  act  and  react  so  as  to  keep  up  each  other's  activity : 
the  full  or  rapid  blood-stream  stimulates  the  nerve-elements, 
and  the  excited  nerve-elements  in  turn  attract  and  keep  up  an 
active  circulation  :  we  conld  sleep  soundly  if  the  stream  of  blood 
would  only  subside,  and  the  stream  of  blood  would  subside  if 
we  could  only  abate  or  suspend  the  race  of  ideas  through  the 
mind.  Meanwhile  neither  will  begin  to  abate  first.  The  merit 
of  the  several  plans  which  have  been  recommended  as  success- 
ful means  of  inducing  sleep  lies  in  their  fixing  attention  steadily 
upon  some  object  or  event  that  is  itself  of  an  unexciting  nature 
for  a  sufficient  length  of  time  to  allow  all  active  ideas  to  subside. 
To  imagine  a  continuing  monotonous  sound,  or  a  flowing  river,  or 
the  rush  of  a  stream  of  steam  from  the  nostrils,  and  to  hold  the 
attention  to  the  particular  imagination  without  permitting  it  to 
wander  to  more  exciting  ideas,  to  repeat  to  oneself  slowly  lines 
of  poetry,  or  to  go  on  counting  from  one  upwards,  and  the  like, 
are  all  schemes  which  operate  in  that  ^vay ;  and  in  carrying 
them  into  effect  success  will  certainly  be  more  probable,  accord- 
ing to  my  experience,  if  the  breathing  be  deliberately  slackened 
and  the  eyeballs  rolled  upwards  voluntarily,  as  is  done  in- 
voluntarily during  sleep. 

Local  fluctuations  of  the  circulation  may  in  like  manner  be 
supposed  to  be  the  causes  of  dreams  more  limited  in  range  and 
less  coherent  in  character.  Certainly  such  variations  occur, 
although  we  are  not  able  to  specify  the  exact  causes  of  them. 
Looking,  however,  to  the  many  ingoing  channels  of  communica- 
tion between  the  different  organs  of  the  body  and  the  brain  in 
which  they  are  all  represented  locally,  it  is  easy  to  conceive  that 
some  trivial  disorder  of  one  of  them  may  affect  temporarily, 
throuo-h  vaso-motor  nerves,  the  circulation  in  the  cerebral  area 
in  which  it  is  represented :  the  particular  vascular  area  will 
blush  or  become  pale,  as  it  were,  in  sympathy  with  the  state  of 
the  organ.  Baillarger  relates  a  case  which  may  find  a  place 
here  as  fitly  as  anywhere  else.  A  Greek  merchant  had  suffered 
for  a  long  time  from  a  hsemorrhoidal  flux,  which  was  suppressed 


I.]  SLEEP  AND  DREAMING.  41 

at  last  by  treatment.  But  he  began  immediately  to  suffer  pains 
in  his  head,  without  however  exhibiting  any  trace  of  delirium. 
A  singular  phenomenon  too  presented  itself :  every  night  he 
had  a  dream  in  which  he  imagined  that  he  possessed  immense 
wealth,  and  that  he  distributed  fortune  and  honours  to  all  around 
him.  The  recurrence  of  the  dream  night  after  night  struck  him 
as  so  extraordinary  that  he  spoke  about  it  to  his  friends.  After 
a  short  time  delirium  broke  out,  characterised  by  the  same  con- 
ceptions as  for  fifteen  days  had  occurred  during  sleep :  in  fact, 
the  exalted  delirium  was  only  a  continuation  of  the  dream.  It 
may  be  surmised  that  in  this  case  there  was,  in  consequence  of 
the  suppression  of  the  hsemorrhoidal  flux,  a  disturbance  of  the 
cerebral  circulation  which  show^ed  itself  first  in  the  troubles  of  the 
head  and  afterwards  in  the  dream  of  the  night,  and  that  the  vas- 
cular disturbance,  with  the  special  cerebral  activity  accompany- 
ing it,  became  after  a  time  a  chronic  and  permanent  derangement. 
The  quality  of  the  blood  is  a  not  less  important  factor  than 
the  quantity  and  the  distribution  of  it.  Foreign  matters  bred  in 
it  or  introduced  into  it  from  without  increase,  lessen,  or  pervert 
the  functions  of  the  supreme  cerebral  centres,  giving  rise  to 
temporary  exaltation  of  mental  energy,  to  stupor  and  coma,  and 
to  delirium.  The  constant  changes  in  the  constitution  of  the 
blood,  which  are  the  consequences  of  its  use  and  renewal  in  the 
nutrition  of  the  tissues,  its  life-history  being  a  continued  meta- 
stasis, will  undergo  such  modifications  from  time  to  time  as  to 
generate  substances  that  may  act  upon  the  nerve-centres,  as 
upon  other  tissues  of  the  body,  to  excite  or  to  depress  or  to 
derange  their  functional  activity  ;  and  it  is  obvious  that  the  cir- 
culation of  such  products  in  the  blood  may  be  the  active  occasion 
of  dreaming.  Blood  that  is  impoverished  through  deficiency  of 
one  of  its  essential  constituent  elements,  as  in  anaemia,  where 
iron  is  wanting,  or  is  impure  by  reason  of  the  retention  in  it  of 
some  effete  products  of  the  tissues  which  should  be  excreted,  as 
when  hindered  respiration  prevents  it  being  properly  decar- 
bonised, or  when  some  constituent  of  the  bile  accumulates  in  it, 
or  when  the  uric  acid  which  should  be  drained  off  by  the  kidneys 
is  retained  in  it,  may  be  confidently  expected  to  act  upon  the 
brain  in  sleep  as  powerfully  as  it  does  when  awake. 


42  PATHOLOGY  OF  MIND.  [chap. 

Let  it  not  be  overlooked  in  relation  to  this  matter  that  the  viti- 
ated or  altered  blood  will  act  upon  any  nerve-centre,  whether 
sensory,  motor,  vaso-motor,  or  ideational.  Subjective  visual  sensa- 
tions, such  as  bright  spots,  circles  of  light,  coloured  patches,  vague 
figures,  that  are  due  to  direct  irritation  of  the  retina  or  its  central 
ganglion,  and  which  may  be  observed  almost  always  just  before 
going  to  sleep,  if  we  only  take  notice  of  them,  will  originate  a 
dream  or  be  woven  into  it ;  motor  intuitions  will  be  excited  in 
like  manner  by  the  action  of  the  vitiated  blood  upon  their 
nerve-centres  ;  it  will  act  again  upon  the  vaso-motor  centres 
which  regulate  the  contraction  of  the  blood-vessels,  and  so  affect 
secondarily  the  circulation  within  the  brain ;  and  by  reason  of 
its  distribution  through  the  supreme  nerve-centres  it  will  stimu- 
late ideas  mechanically,  independently  of  the  usual  links  of 
association,  and  so  probably  occasion  very  incoherent  dreams 
marked  by  rapid  transformations  and  grotesque  inconsistencies. 

Dreams  are  sometimes  found  to  go  before  a  severe  bodily  illness, 
which  they  seem  to  foretell :  before  the  delirium  of  fever  breaks 
out  the  patient  is  much  disquieted  and  distressed  by  vivid  and 
gloomy  dreams,  of  which  the  delirium  appears  as  a  continua- 
tion ;  and  during  the  progress  of  fever,  wdien  he  is  not  actually 
delirious,  all  inclination  to  sleep  is  banished,  though  he  would 
give  all  he  has  to  get  sleep,  painful  thoughts  chase  one  another 
in  rapid  succession  through  the  mind,  and  he  is  overwhelmed 
with  a  terrible  feeling  of  profound  depression  and  vague  dread, 
the  indescribable  misery  of  which  he  declares  he  would  not  choose 
to  go  through  again  for  all  that  the  world  can  give.  Did  the 
invention  of  hell  need  any  explanation  the  mental  sufferings  of  a 
delirious  patient  in  some  instances  might  furnish  it.  An  out- 
break of  acute  mania  of  an  elated  character  is  sometimes  pre- 
ceded by  dreams  of  a  joyous  and  elated  character,  and  sad  and 
gloomy  dreams  in  like  manner  often  go  before  and  presage  an 
attack  of  melancholia.  I  was  consulted  on  one  occasion  by  a 
lady  who  had  suffered  from  several  attacks  of  profound  melan- 
cholia, each  of  which  had  lasted  for  about  four  months ;  they 
were  separated  by  longer  intervals  of  sane  and  busy  cheerful- 
ness, during  which  she  was  as  unlike  as  possible  what  she  was 
when  she  was  afflicted.     The  notable  circumstance  in  her  case 


I.]  SLEEP  AND  DREAMING.  43 

was  that  before  an  attack  she  invariably  dreamed  that  she  was 
suffering  from  it,  and  before  it  passed  off  as  invariably  dreamed 
that  she  had  recovered  and  was  cheerful  and  well.  So  certain 
were  these  dream-presages  that  they  had  never  failed  to  occur 
and  had  never  deceived  her.  And  yet  she  did  not  feel  more 
cheerful  just  before  she  recovered,  nor  more  energetic  imme- 
diately after  her  recovery ;  on  the  contrary,  for  two  or  three 
days  before  the  attack  passed  off  she  was  more  wretched  than 
ever,  and  far  more  irritable,  so  that  she  was  inclined  to  smash 
everything  about  her;  and  immediately  after  it  passed  off  she 
was  exhausted,  felt  very  feeble,  and  was  unable  to  make  the 
least  exertion.  Before  the  attack  there  always  occurred  ex- 
actly the  same  symptoms  of  digestive  disorder,  which  no  kind 
of  treatment — and  many  things  had  been  tried — assuaged  in 
the  least :  the  tongue  became  remarkably  red,  she  could  take 
little  or  no  food,  and  there  was  obstinate  diarrhoea.  The  symp- 
toms no  doubt  pointed  to  a  primary  affection  of  the  great  sym- 
pathetic nervous  system,  which  was  followed  in  a  little  while  by 
cerebral  disturbance  ;  and  it  would  certainly  appear  that  the 
brain  felt  the  symj^athetic  trouble  in  sleep,  and  so  forefelt  and 
foretold  the  impending  calamity  in  its  dreams,  before  it  had 
waking  consciousness  of  it,  just  as  in  like  manner  it  forefelt  and 
foretold  recovery. 

I  know  not  certainly  whether  the  state  of  the  blood  has  any- 
thing to  do  with  the  dreaming  which  occurs  in  connection  with 
certain  diseases,  but  it  is  probable  enough  in  some  cases.  The 
inquiry  is  one  which  may  be  set  down  as  having  yet  to  be  made. 
All  that  we  are  meanwhile  warranted  to  conclude  positively  is 
that  the  quality  of  the  blood  is  a  real  factor  in  the  stimulation 
and  depression  of  the  cerebral  and  other  nerve-centres,  and 
therefore  in  the  causation  of  dreaming.  It  may  act  directly  or 
indirectly  to  produce  its  effect :  directly  upon  the  supreme 
cerebral  centres  so  as  to  excite  irregular  function  in  them,  or 
directly  on  the  sympathetic  nervous  system,  and  indirectly  on 
the  brain,  whereby  a  deep  disturbance  of  the  affective  nature  is 
produced  and  gives  its  predominant  tone  to  the  dream. 

6.  The  Condition  of  the  Kervons  System. — Little  considera- 
tion is  needed  to  show  how  difficult  it  must  be  to  treat  of  the 


44  PATHOLOGY  OF  MIND.  [chap. 

condition  of  tlie  nervous  system  separately  from  the  quality  and 
activity  of  the  blood  ;  in  truth,  they  constitute  together  a  com- 
pound state  rather  than  distinct  co-operating  conditions.  The 
vital  interchanges  between  tlie  blood  and  the  nerve  cell  which 
are  constantly  going  on  are  an  essential  part  of  the  function  of 
the  latter  as  a  living  cell ;  without  them  it  could  not  exercise 
any  function  at  all,  being  in  itself  a  sort  of  mechanical  frame- 
work which  is  kept  in  action  by  the  plasma  supplied  from  the 
blood  that  it  uses  and  exhausts  in  its  function  ;  it  feels  therefore 
the  least  changes  in  the  quality  of  the  supply.  But  the  structure 
itself  wears  out  in  time ;  it  wears  out  naturally  with  the  decay 
of  old  age,  and  it  will  wear  out  prematurely  if  an  undue  stress  be 
put  upon  it  habitually.  The  blood  has  not  only  to  supply  in  the 
rich  plasma  the  high  potential  force  which  is  to  be  made  actual 
energy  in  the  discharge  of  nerve-function,  but  it  has  to  keep  in 
repair  the  nerve-structure  ;  and  this  it  must  fail  to  do  when  the 
latter  is  subjected  continuously  to  an  excessive  strain.  Because 
then  of  the  deterioration  which  may  be  produced  in  nerve- 
elements  by  stress  of  function  as  well  as  by  natural  decay,  and 
because  also  of  temporary  modifications  of  nerve-tone  which 
seem  to  be  produced  by  unknown  atmospheric  conditions,  I 
have  thought  it  fitting  to  group  the  facts  relating  to  the  direct 
state  of  the  nervous  system  under  a  separate  heading. 

A  state  of  moderate  nervous  exhaustion,  whether  from  the 
fatigue  of  mental  or  bodily  exercise  or  from  some  other  cause,  is 
notably  most  favourable  to  the  induction  of  sleep.  But  when 
the  exhaustion  is  carried  to  excess  the  propitious  conditions  are 
gone,  and  the  person  cannot  sleep  at  all,  or  cannot  sleep  soundly  : 
he  may  get  fitful  snatches  of  unrefreshing  slumber  in  which  he 
is  pursued  by  dreams  that  are  so  like  the  rambling  incongruities 
of  half-waking  fancy  as  to  leave  him  in  doubt  whether  he 
actually  slept  or  not.  It  is  a  well-known  experience  that  a 
moral  shock  or  a  great  trial  which  has  produced  much  emotional 
agitation  or  strain  in  the  day  will  trouble  the  slumbers  of  the 
night  with  distressing  dreams  ;  and  it  is  equally  certain,  though 
it  is  perhaps  not  so  well  known,  that  an  exhausted  and  depressed 
state  of  the  nervous  system  owing  to  indulgence  in  excesses  of 
any  kind,  and  especially  sexual  excesses,  will  have  the  same 


1.]  SLEEP  AND  DREAMING.  45 

effect.  The  dreams  which  occur  under  these  conditions  betray 
their  origin  by  their  character.  They  are  disa,greeable  or  dis- 
tressing dreams  of  being  encompassed  by  difficulties  or  troubles 
of  some  kind  or  other — the  exponents  of  a  condition  of  organic 
element  which  means  a  reduction  of  its  vitality.  For  a  moral 
strain  or  a  physical  excess  is  able  to  produce  the  same  physical 
effects  in  the  cerebral  nerve-centres — namely,  consumption  of 
energy  and  lowered  vitality ;  and  the  lowered  vitality  becomes 
in  dreams  an  oppression  or  a  check  or  a  humiliation  of  self, 
just  as  a  bodily  pain  wdiich  w^e  are  suffering  when  w^e  go  to 
sleep  becomes  transformed  sometimes  into  the  persecutor  of  our 
dream.  We  cannot  be  too  mindful  of  the  physical  effects  of 
moral  causes  ;  a  moral  shock  may  kill  as  instantly  and  surely  as 
a  stroke  of  lightning,  and  when  it  does  so  its  operation  and 
effect  are  as  certainly  physical  in  the  one  case  as  in  the  other. 
Nor  can  w^e  be  too  mindful  of  the  effects  of  exhausting  physical 
conditions  upon  mental  tone  and  power. 

Whosoever  is  so  unhappy  as  to  have  habitually  sleepless  nights 
and  bad  dreams  should  bethink  him  that  his  health  requires 
attention  ;  for  in  some  way  or  other  he  is  not  living  wisely.  A 
prudent  man  will  indeed  use  his  dreams  as  a  sort  of  health-gauge. 
When  Hamlet  declared  that  he  could  live  bounded  in  a  nut- 
shell and  count  himself  a  king  of  infinite  space,  were  it  not  that 
he  had  bad  dreams,  he  was  suffering  from  the  great  moral  com- 
motion produced  by  the  appalling  revelation  of  his  father's 
murder,  which  his  father's  ghost  had  made  to  him,  and  from  the 
terrible  strain  of  the  obligation  laid  upon  him  to  avenge  that 
crime ;  his  dreams — if  we  may  take  him  to  mean  literally  w^hat 
he  said — w^ere  the  signs  and  the.  effects  of  an  exhaustion  of 
nervous  energy  which  might  have  overthrown  a  less  strong  mind 
in  madness.  Over-work  and  anxiety  are  well-known  causes  of 
sleepless  nights  and  bad  dreams ;  but  in  some  cases  of  supposed 
over-w^ork  I  am  convinced  that  the  evil  result  which  excites 
alarm  is  owing  not  so  much  to  overstrain  of  mind  as  to  im- 
prudent excess  in  other  respects.  The  over-indulgences  of  life 
are  really  more  to  blame  in  such  cases.  The  man  of  business 
goes  through  the  daily  routine  of  his  work  with  no  more  variety 
of  impressions  than  is  occasioned  by  an  extra  cause  of  worry  or 


46  PATHOLOGY  OF  MIND.  [chap. 

by  a  chance  stroke  of  good  or  ill  fortune ;  lie  has  no  interests 
outside  it,  and  Avhen  he  is  not  occupied  in  it  he  has  no  resource 
but  to  eat  and  sleep ;  probably  he  eats  grossly,  drinks  freely, 
and  is  not  less  free  in  sexual  indulgence;  and  this  goes  on  from 
day  to  day  and  from  year  to  year  until,  as  the  elasticity  of  the 
system  wanes  with  advancing  manhood,  he  has  to  seek  advice 
from  a  physician  because  his  sleep  fails  him,  his  work  tries  him 
as  it  never  used  to  do,  he  is  irritable,  and  he  feels  overworked. 
It  is  from  sensual  indulgence  and  the  exhaustion  consequent 
thereupon,  and  from  a  neglect  of  mental  hygiene,  that  he  suffers 
primarily ;  the  work  of  his  life  might  have  been  done  without 
strain  if  he  had  not  exhausted  his  capital  by  the  steady  drain  of 
habitual  slight  excesses,  and  so  made  a  great  burden  of  his  daily 
duty.  But  I  will  not  pursue  these  matters  further  now  ;  I  have 
touched  upon  them  by  the  way  only  to  make  plain  the  similarity 
of  results  as  regards  sleep  and  dreaming  between  the  effects  of  the 
moral  and  the  physical  causes  of  exhaustion  of  nerve-element. 

When  the  nervous  structure  undergoes  impairment  in  old 
age,  the  decay  is  natural,  and  I  know  not  that  the  dreams  of  old 
persons  are  particularly  distressing.  The  decay  of  age  is  not, 
like  a  disease,  an  invader  against  which  the  organic  forces  rise 
in  defence,  and  defend  themselves  with  more  or  less  success ;  the 
organism  acknowledges  and  accepts  it  rather  as  a  natural  decline 
that  makes  its  descent  to  death  easy.  What  we  observe  in  old 
age  is  that  the  distinction  between  sleep  and  waking  is  less 
marked  than  in  youth  and  manhood,  both  being  less  com- 
plete: nature  as  it  approaches  its  last  sleep  is  fashioned  for 
the  journey.  When  decay  reaches  its  last  stage  before  death, 
and  life  is  iiickering  before  it  expires,  there  are  rambling  reveries 
which  are  very  like  dreams,  and  dreams  that  show  like  feeble 
delirious  wanderings.  Lord  Jeffrey,  in  the  last  letter  which  he 
wrote  the  day  before  his  death,  gives  the  following  account  of 
himself :  "  I  don't  think  I  have  had  any  proper  sleep  for  the 
last  three  nights,  and  I  employ  portions  of  them  in  a  way  that 
seems  to  assume  the  existence  of  a  sort  of  dreamy  state,  lying 
quite  consciously  in  my  bed  with  my  eyes  alternately  shut  and 
open,"  and  seeing  curious  visions.  He  saw  part  of  a  proof-sheet 
of  a  new  edition  of  the  Apocrypha,  and  all  about  Barach  and  the 


I.]  SLEEP  AND  DKEAMING.  47 

^laccabees,  and  read  a  great  deal  in  it  with  much  interest ;  and 
a  huge  Californian  newspaper  full  of  all  manner  of  old  adver- 
tisements, some  of  which  amused  him  much  by  their  novelty. 
"  I  had  then  prints  of  the  vulgar  old  comedies  before  Shakespeare's 
time,  which  were  disgusting.  I  could  conjure  up  the  spectacle 
of  a  closely-printed  political  paper  filled  with  discussions  on 
free-trade,  protection,  and  colonies,  such  as  one  sees  in  the 
Times,  the  Economist,  and  the  Daily  News.  I  read  the  ideal 
copies  with  a  good  deal  of  pain  and  difficulty,  owing  to  the 
smallness  of  the  type,  but  with  gi-eat  interest,  and,  I  believe, 
often  for  more  than  an  hour  at  a  time ;  forming  a  judgment  of 
their  merits  with  great  freedom  and  acuteness,  and  often  saying 
to  myself:  '  This  is  very  cleverly  put,  but  there  is  a  fallacy  in  it 
for  so  and  so.'  "^  The  literary  pursuits  of  his  life  gave  their 
character  to  the  flickering  energies  of  his  failing  nervous  centres, 
and  the  critical  habit  of  his  mind  showed  itself  in  its  final 
operations. 

The  dreams  of  childhood  are  sometimes  of  a  painful  character, 
being  accompanied  by  great  terror  and  distress.  The  most 
terrifying  dream  which  I  remember  ever  to  have  had,  which 
made  me  most  unhappy  for  a  whole  day  and  fearful  of  going  to 
bed  the  next  night,  and  the  chief  incident  of  which  I  can  yet 
recall,  was  one  which  I  had  at  the  earliest  period  of  life  almost 
of  which  I  have  any  recollection.  Without  doubt  the  causes  of 
most  of  these  dreams  of  childhood  are  to  be  found  in  the  bodily 
disturbances  which  are  produced  by  teething,  indigestion,  un- 
suitable food,  and  the  like :  the  bodily  oppression  or  suff'ering  is 
interpreted  mentally  in  such  forms  of  terror  and  affliction  as 
the  child's  imagination  has  been  indoctrinated  with,  and  it  is 
accordingly  scared  with  visions  of  lions  or  tigers,  or  wicked  old 
men  that  come  to  carry  off  naughty  children.  The  emotional 
life  preponderates  much  over  the  intellectual  life  in  children, 
who  are  commonly  either  in  a  state  of  joy  or  grief,  laughing  or 
crying ;  they  are  consequently  very  susceptible  to  fear,  just  as 
savages  are;  indeed  it  can  hardly  be  otherwise  when  their 
individual  helplessness  is  in  such  strong  contrast  with  the 
seemingly  mighty  powers  of  things  around  them,  and  when  they 

^  Jeffrey's  Life  and  Correspondence,  by  Lord  Cockburn,  vol.  i.  p.  407. 


48  PATHOLOGY  OF  MIND  .   [chap. 

have  not  in  their  minds  stored  up  experiences  to  enable  them 
to  correct  or  control  by  reflection  the  present  image  of  terror, 
which  furthermore  acquires  in  dreams  an  extraordinarily  vivid 
intensity  because  of  the  absence  of  all  distracting  or  modifying 
states  of  consciousness.  We  witness  a  striking  illustration  of 
the  isolated  intensity  of  a  terrifying  dream- image  in  that  form  of 
nightmare  in  which  a  child  of  a  nervous  constitution  shrieks 
out  in  the  greatest  apparent  distress,  staring  wildly  at  some 
imaginary  object,  and  from  which  it  cannot  be  awakened  for 
some  time  notwithstanding  its  outcry ;  it  is  truly  in  an  ecstasy 
of  terror ;  there  is  a  convulsive  activity  of  the  terrifying  idea, 
and  for  the  time  the  nervous  centres  are  entirely  insusceptible 
to  other  impressions.  In  the  morning  the  child  has  not  the 
least  remembrance  of  what  has  occurred  :  how  should  it  remem- 
ber when  the  mental  state  was  isolated  by  its  convulsive  energy  ? 
Another  circumstance  to  be  noted  about  dreaming  children  is 
that  they  often  talk  in  their  sleep,  the  ideas  being  translated 
into  movements  of  speech  directly  as  they  arise,  or,  if  they  are 
of  a  terrifying  character,  into  cries  of  distress ;  in  the  same  way 
horses  neigh  and  kick,  and  dogs  bark  and  tremble,  in  their  sleep. 
It  is  probably  in  some  sort  a  consequence  of  this  direct  reflection 
of  ideas  into  movements  in  children  and  of  the  fewness  of  their 
ideas  that  they  seldom  remember  their  dreams  ;  and  it  is  interest- 
ing to  note  in  this  relation  that  there  are  some  grown-up  persons 
who  when  they  talk  much  in  their  sleep  cannot  remember  their 
dreams,  but  remember  them  perfectly  well  when  they  do  not 
talk. 

Concerning  the  atmospheric  conditions,  whether  of  electrical 
or  other  obscure  nature,  which  may  modify  the  tone  of  the  nervous 
system  and  so  affect  the  soundness  of  sleep  and  the  tendency 
to  dream,  there  is  nothing  more  to  be  said  than  that  an  influence  of 
the  kind  is  very  probable,  although  we  have  not  yet  any  exact 
knowledge  of  it.  Systematic  observations  are  entirely  wanting. 
I  am  not  aware  that  any  one  has  yet  been  at  the  pains  to  make 
a  long  series  of  observations  of  his  sleep  and  dreams  and  to 
compare  it  with  a  corresponding  series  of  meteorological  observa- 
tions. But  I  doubt  not  from  my  own  experience  that  we  do 
vibrate  in  unison   with  more  subtle  influences  of   earth  and 


i.J  SLEEP  AND  DREAMING.  49 

sky  than  we  can  yet  measure  in  our  philosophy.^  Dreams 
have  been  a  neglected  study  ;  nevertheless  it  is  a  study  which  is 
full  of  promise  of  abundant  fruit  when  it  shall  be  earnestly 
undertaken  in  a  painstaking  and  methodical  way  by  well-trained 
and  competent  observers.  To  physicians  of  all  men  is  it  likely 
that  they  will  prove  full  of  instruction. 

'  How  great  is  the  effect  upon  some  persons,  both  in  the  day  and  in 
the  night,  of  that  oppressive  state  of  the  atmosphere  which  precedes  and 
accompanies  a  thunderstorm  !  I  hare  thought  sometimes  that  the  brain 
of  an  aged  person,  who  has  led  a  life  of  great  activity — perhaps  never 
having  had  a  day's  ilhiess,  as  it  is  said — has  collapsed  suddenly  in  such 
atmospheric  conditions. 


CHAPTER    ir. 

HYPNOTISM,    SOMNAMBULISM,   AND   ALLIED    STATES. 

Under  sucli  names  as  mesmerism,  animal  magnetism,  electro- 
biology,  hypnotism  and  braidism,  have  been  described,  and 
more  or  less  carefully  investigated,  certain  abnormal  mental 
states,  of  a  trance-like  nature,  which  are  induced  artifically  by 
suitable  means.  Too  long  they  were  rejected  as  sheer  impostures, 
unworthy  of  serious  study,  partly  because  they  undoubtedly 
yielded  easy  occasions  to  knaves  to  practise  deceit  for  their 
pleasure  or  their  profit,  and  partly  because  they  seemed  to  be 
inconsistent  with  known  physical  laws.  Had  the  interpretation 
given  of  them  by  those  who  were  eager  to  discover  something 
marvellous  been  the  only  possible  one,  there  would  certainly 
have  been  a  blank  contradiction  of  known  physical  laws.  But 
it  was  not  so  :  when  close  and  critical  attention  was  given 
to  the  phenomena  it  was  soon  perceived  that  they  might 
be  genuine,  though  they  were  interpreted  wrongly;  and  the 
scientific  study  of  them,  imperfect  as  it  yet  is,  has  shown  that 
they  are  consistent  with  certain  other  obscure  nervous  phenomena, 
and  has  been  useful  in  throwing  some  light  upon  the  manner  of 
working  of  nervous  functions.  A  good  use  of  uncommon  things 
is  to  force  us  to  look  more  curiously  at  the  meaning  of  common 
things  which  we  OA^erlook  habitually.  These  abnormal  phe- 
nomena have  not  yet,  it  is  true,  been  brought  under  the  domain 
of  law,  because  we  have  not  sufQcient  knowledge  of  the  exact 
conditions  of  their  occurrence  to  enable  us  to  define  the  laws 
which  govern  them,  and  because  their  changeful,  irregular,  and 
seemingly  capricious  and  lawless  character  puts  great  difficulties 


CH.  II.]    HYPNOTISM,  SOMNAMBULISM,  AND  ALLIED  STATES.    51 

in  the  way  of  systematic  inquiries ;  but  it  is  not  seriously  dis- 
puted now  that  they  will  ultimately  have  their  proper  place  in 
an  orderly  and  complete  exposition  of  nervous  functions. 

When  a  person  was  thrown  into  this  sort  of  abnormal  mental 
state  by  the  influence  of  another  person  upon  him,  the  question 
was  whether  the  effect  was  due  to  some  subtle  and  unknown 
force  that  emanated  from  the  nervous  system  of  the  operator 
and  was  transmitted  to  the  person  operated  upon,  or  whether  it 
was  due  to  the  excitement  of  the  latter's  imagination — in  other 
words,  to  the  condition  of  extraordinary  activity  into  which  his 
nervous  system  was  brought.  Those  who  were  eager  that 
strange  and  mysterious  phenomena  should  have  extraordinary 
and  mysterious  causes  hastened  forthwith  to  invent  new  forces 
which  they  called  mesmeric,  magnetic,  odylic,  and  the  like  ;  they 
were  loath  to  believe  that  they  had  to  do  only  with  phenomena 
which,  thouoh  strange  and  aberrant,  mis^ht  vet  be  referred  to  the 
operation  of  known  causes,  and  to  search  patiently  whether  there 
were  not  other  phenomena,  neglected  because  less  striking,  with 
which  they  might  be  compared  and  classified.  The  inquiry,  had 
it  been  carefully  and  candidly  made,  would  have  shown  that 
they  were  extreme  instances  of  the  operation  of  known  laws. 

Let  us  go  on  to  consider  then  w^hat  these  abnormal  phenomena 
are  and  how  they  are  produced.  After  being  induced  to  look 
intently  at  the  operator,  or  so-called  magnetiser,  who  attracts  his 
attention  by  making  a  few  gentle  passes  with  his  hand,  or  by 
holding  some  bright  object  before  his  eyes  at  a  little  distance 
from  them,  or  by  merely  looking  fixedly  at  him,  after  a  short 
time  the  person  operated  upon  falls  into  a  trance-like  state,  in 
which  the  ordinary  functions  of  his  mind  are  suspended,  his 
reason,  judgment,  and  will  being  in  complete  abeyance,  and  he  is 
dominated  by  the  suggestions  which  the  operator  makes  to  him. 
He  feels,  thinks,  and  does  whatever  he  is  told  confidently  that  he 
shall  feel,  think  and  do,  however  absurd  it  may  be.  If  he  is 
assured  that  simple  water  is  some  bitter  and  nauseating  mixture 
he  spits  it  out  with  grimaces  of  disgust  when  he  attempts  to 
swallow  it ;  if  he  is  assured  that  what  is  offered  to  him  is  sweet 
and  pleasant,  though  it  is  bitter  as  wormwood,  he  smacks  his 
lips   as   if  he  had  tasted   something  pleasant ;   if   he   is  told 


52  PATHOLOGY  OF  MIND.  [chap. 

that  he  is  taking  a  pinch  of  snuff  when  there  is  not  the 
least  particle  of  snuff  on  liis  finger,  he  sniffs  it  and  instantly 
sneezes ;  if  warned  that  a  swarm  of  hees  is  attacking  him 
he  is  in  the  greatest  trepidation,  and  acts  as  if  he  were 
vigorously  beating  them  off.  The  particular  sense  is  dominated 
by  the  idea  suggested  to  the  mind,  and  he  is  very  much  in  the 
position  of  an  insane  person  who  believes  that  he  smells  dele- 
terious odours,  tastes  poison  in  his  food,  or  is  covered  with 
vermin,  when  he  has  the  delusion  that  he  is  afflicted  in  one 
or  other  of  these  ways  ;  or  in  the  position  of  the  dreamer  who  is 
entirely  under  the  dominion  of  the  imaginary  perception  of  the 
moment,  however  extraordinary,  ludicrous,  or  distressing  it  may 
be.  He  will  in  vain  make  violent  and  grotesque  exertions  to 
lift  his  arm  or  his  leg  when  he  has  been  confidently  told  that  he 
cannot  do  it.  In  no  case  could  he  do  this  if  he  had  not  the 
belief  that  he  could  do  it,  and  he  is  impotent  therefore  to  do  it 
when  he  has  the  strong  belief  that  he  cannot  do  it :  the  growth 
of  a  child's  doings  is  the  growth  of  its  beliefs  that  it  can  do. 
His  own  name  he  may  know  and  tell  correctly  when  asked  to  do 
so,  but  if  it  is  affirmed  positively  to  be  some  one  else's  name  he 
believes  the  lie  and  acts  accordingly ;  or  he  can  be  constrained 
to  make  the  most  absurd  mistakes  with  regard  to  the  identities 
of  persons  whom  he  knows  quite  well.  There  is  scarcely  an 
absurdity  of  belief  or  of  deed  to  which  he  may  not  be  compelled, 
since  he  is  to  all  intents  and  purposes  a  machine  moved  by  the 
suggestions  of  the  operator.  It  is  interesting  to  note,  however, 
that  he  will  not  commonly  do  an  indecent  or  a  criminal  act ;  the 
command  to  do  it  is  too  great  a  shock  to  the  sensibilities  of  the 
brain,  and  accordingly  arouses  its  suspended  functions.  The 
sensibilities  of  the  different"  senses,  or  of  one  or  more  of  them, 
may  be  exalted,  but  at  other  times  they  are  abolished,  the  con- 
dition being  very  much  that  of  complete  trance,  and  the 
insensibility  so  great  that  the  severest  surgical  operations  have 
been  performed  without  eliciting  the  least  sign  of  feeling.^  When 
the  person  comes  back  to  a   state  of  normal  consciousness  the 

1  In  1859  two  eminent  French  surgeons,  Velpeau  and  Broca,  performed 
surgical  operations  upon  twenty-four  women  who  had  been  put  in  the 
hypnotic  state  by  Braid's  method,  without  pain. 


11.]     HYPMOTISM,  SOMNAMBULISM,  AND  ALLIED  STATES.       53 

illusions  disappear  instantly,  his  senses  recover  tlieir  natural 
sensibilities,  and  liis  mental  faculties  resume  their  suspended 
functions  ;  but  in  some  cases  a  little  time  must  elapse  before  he 
regains  his  natural  control  over  himself,  and  it  will  be  more  easy 
to  throw  him  into  the  abnormal  state  on  another  occasion. 

The  conditions  of  the  induction  of  the  abnormal  state  of 
consciousness  seem  to  be,  first,  a  nervous  system  that  is  more 
than  usually  susceptible  and  unstable,  and,  secondly,  the  exercise 
of  a  fixed  and  strained  attention  for  a  short  time.  With  regard 
to  the  first  condition.  Baron  Eeichenbach,  who  was  a  sincere 
believer  in  the  action  of  a  special  force,  w^hich  he  called  odic 
force,  gives  testimony  wdiich  is  the  more  instructive  here  because 
it  comes  from  one  w4io  saw  in  the  phenomena  sometliing  more 
than  natural  nervous  function.  "  I  inquire,"  he  says,  "  among 
all  my  acquaintances  w^hether  they  know  any  one  who  is 
frequently  troubled  wdth  periodical  headaches,  especially  megrim^ 
who  complains  of  temporary  oppression  of  the  stomach,  or  who 
often  sleeps  badly  without  apparent  cause,  talks  in  the  sleep,  rises 
up  or  even  gets  out  of  bed,  or  is  restless  at  night  during  the 
period  of  ftdl  moon,  or  to  whom  the  moonlight  in  general  is 
very  disagTeeable,  or  who  is  readily  disordered  in  churches  and 
theatres,  or  very  sensitive  to  strong  smells,  grating  or  shrill 
noises,  &c.  All  such  persons,  who  may  be  otherwise  healthy,  I 
seek  after  and  make  a  pass  with  my  finger  over  the  palm  of  their 
hands,  and  scarcely  ever  miss  finding  them  sensitive."  Xine 
out  of  ten  of  his  "  sensitives  "  he  found  to  be  females  *'  or  vouths 
of  the  same  nervous  temperament,"  the  majority  of  them  under 
twenty-five  years  of  age,  and  they  all  seemed  to  have  inherited 
their  sensitiveness  from  their  parents.  Obviously  then  a  certain 
neurotic  temperament  is  most  propitious  to  the  induction  of 
the  mesmeric  or  h}qonotic  state.  The  second  condition  is  the 
fixation  of  the  attention  for  a  short  time  throuQ;h  sisjht.  Mr 
Eraid  used  to  make  the  person  look  upon  a  disc  or  some  bright 
object  held  in  front  of  and  a  little  above  the  level  of  the  eyes 
but  the  operator  commonly  looks  him  in  the  face  and  makes  a 
few  gentle  passes  wdth  his  hand  before  his  eyes ;  after  a  little 
w^hile  there  is  a  tremor  of  the  eyes,  the  pupils  dilate,  and  he 
falls  into   the   mesmeric   state.     All  that   the   Abbe   Faria,    a 


54  PATHOLOGY  OF  MIND.  [chap. 

successful  mesmeriser,  used  to  do  was  to  look  fixedly  at  his 
subjects  in  an  impressive  manner  and  to  say  in  an  imposing 
voice,  "  Sleep/'  when  they  instantly  fell  asleep. 

It  was  long  known  to  jugglers,  and  two  hundred  years  ago  it 
was  shown  by  a  Jesuit  priest,  Kischer,  who  attributed  the  effect 
to  magnetism,  that  if  a  cock  or  a  hen  be  grasped  firmly  in  the 
hands  and  held  fast  for  a  short  time  with  its  beak  on  the  ground, 
a  chalk  line  being  drawn  straight  from  the  beak  so  that  its  eyes 
converge  upon  it,  it  remains  there  fixed,  motionless,  and  more  or 
less  insensible  ;  so  much  so  as  not  to  feel  even  the  pricks  of  pins 
that  are  thrust  into  its  body.  It  is  in  a  state  of  hypnotic  sleep. 
The  chalk-line  is  not  really  necessary;  the  simple  handling 
or  holding  of  the  hen  usually  suffices  to  produce  the  effect. 
Morever,  as  Czermak  showed,  the  experiment  may  be  done 
successfully  on  other  animals — on  young  lobsters,  frogs,  geese, 
ducks,  and  even  on  dogs  sometimes;  the  help  of  an  object  to 
gaze  at  being  necessary  in  some  cases.  Something  of  the  same 
kind  occurs,  I  believe,  when  a  cat  fascinates  a  bird  so  that  it 
cannot  make  the  least  exertion  to  escape,  or  actually  drops  from 
its  perch  into  the  paws  of  the  cat.  We  perceive  then  that  by 
giving  a  particular  strain  of  fixed  activity  to  the  nervous  system 
its  ordinary  functions  may  be  suspended,  and  it  may  be  made 
insensible,  so  long  as  the  isolated  activity  continues,  to  the 
impressions  which  ordinarily  aff'ect  it.  What  is  the  intimate 
change  in  the  nerve-element  which  produces  this  state  of  non- 
conduction  between  associated  nerve-centres,  this  discontinuity 
of  function  in  spite  of  continuity  of  connecting  fibres,  we  know 
not ;  it  must  suffice  for  the  present  to  know  that  a  particular 
form  of  activity  is  capable  of  reaching  such  a  pitch  as  to  suspend 
or  inhibit,  while  it  lasts,  the  ordinary  functions  of  the  nervous 
system,  and  to  know^  this  furthermore  by  instances  in  which  the 
supposition  of  a  transmission  of  any  peculiar  force  from  the 
operator  to  the  creature  operated  upon  may  be  confidently  rejected. 

The  mesmeric  or  hypnotic  subject  who  is  for  the  moment 
entirely  under  the  sway  of  the  idea  suggested  by  the  operator  and 
insensible  to  other  impressions  is  in  a  similar  condition  of  par- 
tial activity  and  general  incapacity  of  cerebral  function.  If  we 
reflect,  we    may  call  to  mind  gradational  states   between  this 


II.]     HYPNOTISM,  SOMNAMBULISM,  AND  ALLIED  STATES.      55 

abnormal  form  of  activity  and   the    entirely  normal   exercise 
of  mental  function.     Take,  for  instance,  the  state  of  profound 
reverie   in   which   the   brain    is   so    earnestly   engaged   in    an 
absorbing  reflection,  so  completely  abstracted  thereby  from  the 
usual   paths   of   function,  as  to  render  the  greater  part  of  it 
insusceptible  to  impressions,  and  the  individual  therefore  un- 
conscious of  what  is  going  on  around  him :  sounds   strike  his 
ear  and  he  hears  them  not,  incidents  happen  around  him  and 
lie  notices  them  not,  the  pain  of  disease  may  be  unfelt  in  the 
deep  abstraction  of  his  mind  from  it.     There  is  a  track  or  an 
area  of  activity  lit  up  by  consciousness,  while  all  around  are 
darkness  and  inactivity.     Without  falling  into  this  Archimedes- 
like abstraction,  any  one  may  notice  that  when  he  is  reflecting 
earnestly  on  a  subject  in  which  he  is  deeply  interested  he  is 
scarcely  conscious ;  it  is   only  the  lapses  of  his  attention  that 
make  him  conscious  ;  and  the  same  period  of  time  w^ill  appear 
to  him  as  a  minute   or   an   hour  according  as   he   is    deeply 
absorbed  in  his  subject  or  not.     An  acute  pain  notably  renders 
us  insensible  to  a  less  pain,  though  the  conditions  of  the  latter 
continue  in  operation  ;  the  message  sent  to  the  central  ganglion 
by  it  no  longer  awakens  any  notice,  for  there  is  a  local  suspension 
or   inhibition  of  its   sensory  functions  in  consequence  of  the 
abstraction   of   consciousness   by  a   neighbouring  predominant 
activity.     In  the  same  w^ay  a  severe  neuralgia  may  be  replaced 
by   convulsions,  itself  ceasing  when  they  come  on,   and  may 
return  when  the  convulsions  stop,  the  disordered  energy  being 
transferred,  as  it  w^ere,  from  one  class  of  nerve-centres  to  another. 
In  the  excitement  of  battle  a  wound  is  not  perhaps  felt  at  the 
time  of  its  infliction,  and  some  animals  like  frogs  and  snails 
are  insensible  to  pricking  or  cutting  during  the  act  of  sexual 
copulation:    in   all    animals  indeed  the  acute  sensory   orgasm 
is  incompatible  with  any  distraction  of  thought  or  feeling,  and 
silences  for  the  moment  of  its  transport  any  pang  of  bodily  pain 
whi(jh  there  may  chance  to  be.     I^o  better  example   than  this 
from  the  physiological  life  could  be  given  to  illustrate  a  mode  of 
nervous  function  which  is  exhibited  pathologically  in  certain 
forms  of  hysterical  ecstasy.     The  quasi-cataleptic  and  almost 
insensible   state  of  the   melancholic   patient    whose   mind   is 


56  PATHOLOGY  OF  MIND.  [chap. 

possessed  with  one  terrible  delusion  which  will  not  let  it  go, 
and  the  real  cataleptic,  whose  limbs  retain  for  an  indefinite 
period  whatever  position  may  be  given  to  them  while  he  is 
insensible  to  outward  impressions,  seem  to  be  examples  of  the 
same  mode  of  function. 

Many  more  instances  might  be  mentioned  of  this  kind  of 
induced  discontinuity  or  disruption  of  mental  function  in 
the  supreme  cerebral  centres.  If  a  nervous  person  coming  to  an 
anxious  interview  with  a  superior  is  asked  abruptly  and  harshly 
what  his  name  is,  he  may  clean  forget  it,  just  as  a  nervous 
student  at  an  oral  examination  may  be  unable  to  answer  a 
question  the  answer  to  which  he  knew  quite  well  a  minute 
before,  and  will  know  quite  well  a  few  minutes  afterwards. 
He  is  like  the  hypnotic  who  when  he  is  told  that  he  cannot 
pronounce  a  certain  letter  boggles  and  makes  futile  attempts 
at  its  pronunciation,  but  at  the  same  time  pronounces  it 
unconsciously  in  the  very  words  wdiich  he  uses  to  declare 
that  he  cannot  do  it.  How  often  shall  a  confident  brow  and 
a  bold  assertion  carry  temporary  conviction  to  a  mind 
W'hich  is  struqi^linof  all  the  while  to  resist  belief,  and  which 
is  able,  only  by  quiet  reflection  afterwards,  to  reassert  its 
independence  and  judgment !  ISTervous  and  hysterical  persons 
may  be  made  to  believe  almost  anything  that  a  person  to 
■whom  they  have  yielded  their  confidence,  and  who  has  un- 
bounded confidence  in  himself,  affirms  to  them  positively ; 
and  it  needs  not  to  be  either  nervous  or  hysterical  to  be  power- 
fully influenced  on  the  occasion  of  some  anxious  and  doubtful 
enterprise  by  the  confident  prediction  that  we  shall  succeed 
or  fail;  the  prediction,  whether  well-founded  or  not,  aiding 
materially  in  either  case  to  bring  about  its  own  fulfilment. 
We  may  know  very  w^ell  that  the  person  has  not  adequate 
grounds  in  a  full  knoAvled2[e  of  the  circumstances  to  warrant 
his  prediction,  but  we  are  none  the  less  affected  by  it,  perhaps 
against  our  better  judgment,  and  cannot  help  suffering  our 
energies  to  be  either  on  the  one  hand  distracted  and  w^eakened 
or  on  the  other  hand  concentrated  and  strengthened  by  it. 
There  are  some  persons  whose  habit  of  mind  it  is  to  balance 
reasons  -so    nicely  that  they  find  it  very   hard  to  come  to   a 


II.]     HYPNOTIS:\r,  SOMNAMBULISM,  AND  ALLIED  STATES.       57 

decision,  and  it  is  an  extraordinary  comfort  to  them  when 
another  person  will  endorse  or  even  only  rehearse  the  reasons  on 
one  side  in  a  confident  tone  so  as  to  give  them  a  preponderant 
activity ;  they  feel  the  relief  and  are  resolved,  notwithstanding 
that  the  person  who  has  helped  them  is  not  one  whose  judgment 
they  esteem  much  at  heart,  and  notwithstanding  that  the  con- 
flicting reasons,  when  calmly  weighed,  are  actually  just  as  nearly 
balanced  as  they  were  before. 

It  is  well  known  how  often  a  most  absurd  idea  will  hold 
possession  of  the  mind  in  dreams,  and  although  it  bears  but  a 
very  small  proportion  to  the  multitude  of  latent  ideas  in  the 
mind,  with  some  of  which  it  is  absolutely  incompatible,  we  are 
entirely  at  its  mercy  for  the  time  being,  and  have  not  the  least 
power  to  correct  it.  The  wonder  would  of  course  be  if  we  did 
correct  it  when  it  is  solely  active,  and  if  we  did  not  believe 
it  when  the  rest  of  the  mental  functions,  being  suspended  in 
sleep,  are  not  susceptible  to  stimulation  by  it  or  by  the  custo- 
mary impressions  from  without :  in  such  case  how  can  they 
arise  to  correct  or  to  contradict  it,  or  to  affect  it  in  any  way  ?  In 
the  hypnotic  state  the  idea  is  isolated  by  a  similar  break  of 
functional  continuity  in  the  supreme  centres ;  the  excitation  of 
the  ideational  track  is  such  that,  like  a  spasm  or  convulsion  of 
muscle,  it  escapes  for  a  time  from  the  controlling  influence  of 
surrounding  functions,  and  only,  as  it  subsides,  can  be  brought 
as^ain  into  co-ordination  with  them.  We  see  the  reason  then  of 
the  foro^etfulness  which  is  sometimes  shown  of  what  has  taken 
place  in  the  mind  during  these  abnormal  trance-lik:e  states ;  it 
is  the  result  and  evidence  of  the  extreme  out-of-relationship  of 
the  active  idea,  whatever  it  chanced  to  be,  with  other  ideas, 
Avherefore  there  is  nothing  in  the  ordinary  mental  operations  to 
recall  it.  That  it  should  be  remembered,  that  is  to  say,  should 
recur,  during  these  operations,  would  be  exactly  as  if  a  particu- 
lar convulsive  movement  should  recur  and  take  part  in  a  series  of 
ordinary  natural  movements  with  which  it  is  incompatible  :  the 
irruption  of  the  abnormal  movement  would  be  the  disruption 
and  inhibition  of  the  normal  movements.  Should  there  be, 
during  a  subsequent  trance-like  state,  a  remembrance  of  what 
happened  in  a  former  one,   as  befalls  sometimes,  it  is  because 


58  PATHOLOGY  OF  MIND.  [chap. 

the  same  state  of  things  then  recurs.  Now  instability  of  func- 
tions is  a  character  of  the  so-called  nervous  temperament ;  there 
is  a  tendency  of  ideas  and  movements  to  escape  from  the  bonds 
of  their  functional  relations,  and  to  act  independently — to  break 
away  from  coordinate  and  subordinate  consensus  of  function, 
and  to  become,  so  to  speak,  dis-ovdmeite — not  otherwise  than  as 
an  insane  person  is  apt  to  disregard  the  obligations  of  the  social 
state  and  to  break  out  into  anti-social  behaviour.  It  was  for  this 
reason  that  I  formerly  described  the  temperament  as  the  neurosis 
spasmodica. 

It  might  perhaps  be  set  down  as  a  general  law  that,  given  two 
nerve-centres  of  mental  function,  they  cannot  be  in  equally  con- 
scious function  at  the  same  time ;  if  the  one  is  actively  conscious 
the  other  will  be  sub-conscious,  or  not  conscious  at  all ;  and  if 
the  one  reaches  a  certain  height  of  activity  the  effect  upon  the 
other  will  be  entirely  inhibitory — it  will  be  rendered  temporarily 
incapable  of  function. 

In.  the  hypnotic  state  the  individual  is  on  the  whole  less  sen- 
sible to  external  stimuli  than  in  natural  sleep,  but  more  sensible 
to  the  particular  stimulus  of  the  operator's  voice  than  he  is  to 
any  stimulus  in  natural  sleep,  although,  as  I  have  before  pointed 
out,  there  are  considerable  variations  in  the  degree  of  natural 
sleep,  and  stories  are  told  of  some  persons  who  have  been  almost 
as  susceptible  to  the  suggestions  of  others  as  the  hypnotic  sub- 
ject is.  That  he  should  be  sensible  to  the  operator's  suggestions 
with  whom  he  is  in  sympathetic  relation,  and  not  sensible  to  the 
suggestions  of  a  bystander,  agrees  with  the  experience  that  a 
person  who  is  dreaming  will  sometimes  hear  and  weave  into  his 
dream,  and  perhaps  even  reply  to,  a  question  which  happens  to  be 
in  relation  w^ith  the  idea  of  his  dreams,  or  which  is  put  to  him  by 
a  familiar  voice.  It  agrees  also  with  the  fact  that  in.  the  waking 
state  we  habitually  abstract  consciousness  from  what  we  are  not 
thinking  about,,  admitting  only  such  impressions  as  are  in  rela- 
tion with  our  reflections,  and  rejecting  those  which  are  not ;  and 
this  we  do  not  only  voluntarily,  but  often  without  knowing  what 
we  are  doing,  much  more  without  specially  willing  it ;  it  is  at 
bottom  an  unconscious  process,  like  that  by  which  a  strong 
feeling  arouses  and  fosters   its  sympathetic  ideas,  ignores  and 


II.]     HYPNOTISM,  SOMNAMBULISM,  AND  ALLIED  STATES.       59 

excludes  unsympathetic  ideas.  AVe  have  only  to  exaggerate  in 
imagination  this  condition  of  normal  reflection — to  suppose  it 
to  deepen  through  different  depths  of  reverie,  until  it  reaches 
the  morbid  degree  of  hypnotism — and  we  shall  have  a  partial 
mental  function  with  susceptibility  to  related  impressions  and  a 
complete  inhibition  of  the  rest  of  the  mental  functions. 

"When  a  person  has  been  so  unwise  as  to  suffer  himself  to  be 
thrown  many  times  into  the  hypnotic  state  he  is  very  easily  af- 
fected ;  the  expectant  idea  will  induce  the  state  without  anything 
whatever  being  put  before  the  eyes.  Eeichenbach's  experiments 
on  his  sensitive  subjects  whom  he  kept  in  his  house  proved,  in  a 
ludicrous  way  sometimes,  that  there  was  hardly  any  circumstance 
whatever,  however  trivial  in  itself,  which  might  not  occasion  it 
in  persons  who  expected  it  and  were  accustomed  to  it.  The  habit 
grew  upon  them,  as  we  know  that  habits  of  nervous  action,  good 
or  bad,  normal  or  abnormal,  w^ill  do  if  they  are  encouraged.  In 
the  first  instance,  however,  a  fixing  of  the  attention  throucrh 
vision  seems  to  be  helpful  or  even  necessary,  and  if  the  object 
gazed  at  be  something  so  placed  a  little  above  the  level  of  the 
eyes  as  to  necessitate  a  greater  strain  of  the  ocular  muscles  it 
will  be  more  effectual.  By  fixing  consciousness  in  this  way,  in 
other  words,  by  keeping  up  a  single  act  of  undivided  attention, 
there  is  a  subsidence  of  the  general  activities  of  the  brain,  which 
thereupon  goes  to  sleep.  Were  consciousness  prevented  from 
wandering  by  being  held  in  any  other  act  of  undivided  attention, 
whether  it  were  by  a  mental  image  or  by  a  muscular  strain,  the 
result  would  no  doubt  be  the  same.  The  reason  why  the  hyp- 
notic subject  is  best  affected  through  sight  probably  is  that  his 
attention  is  easily  arrested  so,  and  that  in  no  other  way  would 
he  be  so  capable  of  an  undistracted  act  of  voluntary  attention  for 
any  length  of  time :  ask  him  to  think  of  one  thing  steadfastly 
for  a  few  minutes,  without  ever  allowing  his  attention  to  stray, 
he  would  fail  to  do  so;  but  when  his  attention  is  fixed  in  a 
steadfast  gaze  upon  some  object  to  which  it  is  solemnly  directed, 
with  the  expectation  of  something  extraordinary  being  about  to 
happen,  it  is  held  involuntarily — distraction  of  consciousness  is 
prevented. 

It  is  not  a  mere  harmless  amusement  for  one  who  is  suscep- 


60  PATHOLOGY  OF  MIND.  [chap. 

tible  to  the  hypnotic  trance  to  suffer  himself  to  be  frequently 
practised  upon,  for  there  is  danger  of  his  mind  being  weakened 
temporarily  or  permanently.  Indeed  were  his  will  strong  and 
well-fashioned  the  operation  could  not  succeed,  for  its  success  is 
a  surrender  of  the  subject's  will  to  the  will  of  the  operator,  and 
he  is  sometimes  plainly  conscious  of  a  lessening  resistance  to  the 
latter's  commands  before  he  is  completely  subdued  and  yields 
unconditionally.  After  coming  out  of  the  trance,  a  little  time 
must  elapse  before  his  will  recovers  its  power ;  for  a  while  he 
remains  unduly  susceptible  to  the  suggestions  of  others,  and  too 
easily  influenced  by  commands.  In  the  end,  if  the  practice  be 
continued,  he  is  likely  to  lose  all  control  ov^er  his  own  mind  and 
to  become  insane  ;  the  compact  consensus  of  the  supreme  centres 
has  been  broken  up,  a  dis-ordinate  tendency  fostered,  and  the 
dissociated  centres  are  prone  to  continue  their  abnormal  and 
independent  action.     And  assuredly  that  way  madness  lies. 

I  have  only  to  remark  further  with  regard  to  hypnotism  that 
it  or  a  similar  trance-like  state  is  produced  sometimes  by 
entirely  physical  causes.  It  has  occurred  now  and  then  in  con- 
sequence of  injury  and  of  disease  of  the  brain,  without  our  being 
able  to  trace  the  connection  between  the  particular  injury  or 
disease  and  the  singular  affection  of  consciousness.  It  is  not 
difficult,  however,  to  conceive  that  a  physical  cause  of  irritation 
in  the  brain  may  easily  suffice  for  the  induction  of  a  state  of  non- 
conduction,  general  or  partial,  in  its  delicate  structural  elements, 
and  that  strange  aberrations  of  consciousness  will  ensue  in  con- 
sequence ;  but  of  what  really  happens  we  know  nothing  definite 
at  present. 

The  condition  which  most  resembles  the  hypnotic  state  is 
natural  somnambulism;  indeed  the  former  might  not  unjustly 
be  described  as  an  artificial  somnambulism.  We  observe  great 
differences  in  the  conditions  of  the  senses  in  natural  as  in  artifi- 
cial somnambulism  :  the  person  may  see  without  hearing,  or  hear 
without  seeing;  his  eyes  may  be  shut  or  wide  open;  apparently 
he  may  see  some  things  and  not  see  other  things  that  are  equally 
within  the  field  of  vision  ;  the  sensibility  of  one  or  more  of  the 
senses  may  be  considerably  increased ;  indeed,  the  gradations  of 
sense  in  different  cases  are  such  that  the  somnambulist  may  be 


li.]      IIYPNOTISAJ,  SOMNAMBULISM,  AND  ALLIED  STATES.       61 

on  tlie  one  hand  almost  as  clearly  conscious  of  his  surroundings 
as  when  awake,  or,  on  the  other  hand,  almost  as  unconscious  as 
when  fast  asleep.  Like  the  hypnotic,  he  sometimes  remembers 
during  one  attack  the  events  of  a  former  attack,  although  he  has 
no  remembrance  of  them  w^hile  he  is  in  his  normal  state  of  con- 
sciousness. At  other  times  he  forgets  altogether  everything 
that  happened  during  the  attack :  a  fact  which  is  in  accordance 
with  the  experience  that  the  dreams  in  which  a  sleeper  talks  are 
those  which  are  least  remembered.  In  a  few  instances  he  remem- 
bers something  of  his  dream,  imperfectly  and  confusedly,  espe- 
cially when  a  scene  or  incident  in  the  day  chances  to  recall  it. 

Because  the  somnambulist  plainly  does  not  see  things  near 
him  sometimes,  though  his  eyes  are  open,  and  nevertheless  shows 
by  his  behaviour  that  he  does  perceive  other  things  that  are 
not  so  close  to  him,  it  has  been  supposed  that  he  has  the  power 
to  perceive  through  some  other  channel  than  the  ordinary  senses. 
If  he  manifestly  does  not  see  one  thing  which  is  right  before  his 
eyes,  how  can  he  see  another,  it  may  be  reasonably  asked  ?  The 
answer  is  that  he  sees  wdiat  is  in  relation  with  the  ideas  of  his 
dream :  the  avenue  of  sense  is  open  to  the  apprehension  of  an 
object  the  idea  of  which  is  active  in  his  mind,  and  shut  to  those 
objects  which  are  not  in  relation  wdth  the  images  of  his  dream. 
In  like  manner  he  may  not  hear  some  sounds,  though  they  are 
pretty  loud  and  startling,  and  yet  may  hear  other  sounds  which 
are  woven  into  the  fabric  of  his  dream  and  perhaps  give  a  new 
direction  to  it.  The  occlusion  of  sense  to  what  is  not  necessary 
to  the  immediate  business  is  the  main  reason  probably  why  he 
is  able  to  walk  cleverly  and  fearlessly  over  roofs  of  houses  and 
other  dangerous  places  where  he  would  not  like  to  venture  if 
he  was  broad  awake.  Seeing  only  what  he  requires  to  see  for 
his  purpose,  he  is  not  distracted  by  seeing  other  things  which 
might  dissipate  his  attention,  and  his  undivided  energies  are 
given  imreservedly  to  the  accomplishment  of  what  he  has  to  do. 
The  way  to  do  a  difficult  thing  which  is  feasible  is  not  to  see 
vaguely  the  difficulties,  but  to  see  definitely  the  means  of  success ; 
the  energies  are  then  undistracted  by  any  halting  considerations. 
The  hypnotic,  whom  w^e  may  consider  to  be  in  a  single  state  of 
consciousness,  has  been  known  sometimes  to  execute  feats  of 


G2  PATI-IOLOGY  OF  MIND.  [chap. 

muscular  strength  or  agility  wliicli  he  would  have  found  it 
hard  or  impossible  to  do  in  his  normal  state.  Another  reason 
of  the  fearless  feats  of  the  somnambulist — fearless,  but  not  so 
safe  for  him  always  as  is  popularly  supposed — is  perhaps  the 
heightened  sensibility  of  his  muscular  sense,  by  virtue  of  which, 
like  a  blind  man,  he  is  susceptible  to  finer  impressions,  and 
receives  more  precise  and  certain  information  to  guide  his  move- 
ments. There  is  reason  to  believe  that  the  sensibility  of  the 
other  senses  may  be  increased  sometimes,  as  is  undoubtedly  the 
case  in  artificial  somnambulism  ;  through  a  keener  sensibility  of 
the  retina  he  may  get  an  advantage  of  discriminating  objects  in 
the  dark  equal  to  that  possessed  naturally  by  such  nocturnal 
creatures  as  owls  and  cats  ;  and  the  increase  of  auditory  or  tactile 
sensibility,  by  enabling  him  to  apprehend  such  slight  impressions 
as  he  could  not  discriminate  in  his  normal  state,  might  well 
give  a  miraculous  semblance  to  his  perceptions.  Of  one  of  his 
so-called  "  sensitives  "  Eeichenbach  relates  that  "  all  common 
light  was  a  burthen  to  her,  pained  her,  and  dimmed  the  clearness 
of  her  perception.  Her  sight  was  good  in  proportion  to  the 
depth  of  darkness  about  her."  But  we  have  more  sober  and 
trustworthy  authority,  were  it  needed,  in  the  testimony  of 
Cabanis  and  others  who  have  witnessed  quickened  sensibility 
of  each  sense  in  different  cases  of  artificial  somnambulism. 

JSTotwithstanding  the  high  authority  of  Sir  W.  Hamilton,  who 
declared  that,  however  astonishing,  it  was  "  now  proved  beyond 
all  rational  doubt  that  in  certain  abnormal  states  of  the  nervous 
system  perceptions  are  possible  through  other  than  the  ordinary 
channels  of  sense,"  it  would  not  be  profitable  to  discuss  at 
length  the  question  whether  somnambulists,  natural  or  artificial, 
ever  perceive  otherwise  than  by  their  natural  senses — whether, 
for  example,  they  ever  read,  as  is  sometimes  affirmed,  through 
the  pit  of  the  stomach  or  through  the  back  of  the  head.^  With- 
out doubt  they  sometimes  imagine  they  do :  having  perhaps, 
as  hysterical  women  often  have,  anomalous  sensations  about  the 

1  "It  is  quite  indifferent,"  says  Eeichenbach,  ''to  the  high-sensitives 
whether  tlieir  eyes  are  bandaged  and  glued  over  or  not  ;  it  is  for  them 
about  the  same  as  it  would  be  to  bandage  the  elbow  of  a  non-sensitive 
who  has  good  eyes  to  keep  him  from  seeing  a  camel," 


II.]      HYPNOTISM,  SOMNAMBULISM,  AND  ALLIED  STATES.       63 

epigastrium  or  in  other  parts  of  the  body,  they  misinterpret 
their  character,  and  attribute  to  them  perceptions  which  have 
been  got  actually  in  the  ordinary  way  through  the  natural 
channels.  But  it  invariably  happens,  when  the  extraordinary 
powers  which  they  imagine  or  affirm  themselves  to  have,  and 
which  credulous  folk  believe  them  to  display,  are  rigidly  tested 
by  competent  inquirers,  that  the  miracle  explodes.  They  will 
claim  a  power  of  looking  into  the  bodies  of  other  persons  or 
into  their  own  bodies,  and  will  describe  with  measured  utterance, 
as  if  their  speech  followed  the  gradual  disclosures  of  the  eye, 
the  conditions  of  the  internal  organs  and  the  nature  and  position 
of  any  disease  which  may  be  going  on,  raising  much  wonder 
and  entire  belief  in  the  minds  of  persons  who  are  ignorant  of 
anatomy,  or  who  have  only  a  dim  book-knowledge  of  it ;  but 
when  their  statements  are  tested  by  a  competent  physician  they 
w^ill  be  found  to  be  vague  and  absurd,  such  as  might  have  been 
easily  founded  on  the  remembrance  of  some  anatomical  drawing, 
and  it  will  commonly  be  possible,  by  affecting  an  air  of  entire 
belief,  and  betraying  not  the  least  sign  of  suspicion  of  their 
powers,  to  lead  them  to  the  description  of  all  sorts  of  im- 
possible diseases  in  impossible  places.  They  follow  the  sugges- 
tions made  to  them  in  the  leading  questions  that  are  put,  and 
express  the  vulgar  notions  of  diseases  and  their  treatment,  just 
as  the  spirit  of  a  great  philosopher  or  a  great  poet,  when  it  re- 
visits earth  to  assist  at  a  spiritualistic  sSance,  utters  the  vulgar 
sentiments  and  thoughts  of  the  medium  who  has  summoned  it. 
The  predictions  of  future  events  which  some  of  these  somnam- 
bulistic performers  rise  by  degrees  to  the  audacity  of  making 
are  equally  fanciful ;  when  soberly  tested,  the  prophetic  insight, 
like  their  medical  insight,  proves  to  be  delusive.  They  usually 
grow  to  the  height  of  their  presumption  step  by  step  b.s  they 
succeed  in  imposing  upon  the  amazed  believers  in  their  preten- 
sions, whose  credulity  to  the  end  keeps  pace  with  their  audacity  : 
Eeichenbach  was  convinced  that  no  secret  act  done  in  his  house 
escaped  "  the  all-piercing  eye  of  the  acute  sensitive,"  and  after 
saying  that  they  are  sometimes  of  service  in  the  medical  art, 
by  discovering  the  nature  of  disease  and  foretelling  its  future 
course,  and  by  telling  such  things  as  whether  there  is  a  prospect 
4 


64  PATHOLOGY  OF  MIND.  [chap. 

that  a  woman  will  become  a  mother  and  what  the  sex  of  her 
offspring  will  be,  he  naively  tells  a  story  to  show  how  dangerous 
or  usefid  this  faculty  may  be  : — "  In  my  own  house  it  happened 
tliat  a  somnambulist  whom  I  introduced  there  denounced  a 
servant  girl  for  immoral  conduct,  in  which  nobody  believed,  and 
the  truth  of  her  declaration  was  only  established  after  months ; 
and  other  revelations  which  she  made  caused  a  revolution  in  the 
house  and  resulted  in  the  dismissal  of  several  servants." 

It  will  not  be  amiss  to  consider  briefly  what  are  the  causes 
that  have  given  rise  to  the  belief  in  the  prophetic  and  other 
singular  powers  of  these  somnambulists. 

a.  First  of  all,  then,  there  are  the  genuine  impostors,  who  out 
of  an  itching  desire  of  notoriety  or  for  purposes  of  gain  made  a 
profitable  trade  of  the  business  of  deceit.  From  the  earliest  times 
of  which  we  have  record  unto  the  present  time  there  have  not 
been  wanting  knaves  to  practise  upon  the  credulity  of  fools,  and 
they  have  perforce  found  the  choicest  fields  for  their  enterprise  in 
those  dark  places  of  nature  where  mystery  begets  wonder,  and 
wonder  in  turn  begets  credulity.  Where  the  forces  and  the  laws 
of  nature  are  not  known,  there  has  always  been  a  class  of 
persons  claiming  supernatural  relations  and  pretending  perhaps 
to  supernatural  powers,  who  have  made  their  advantage  out  of 
the  ignorance  and  fears  of  their  fellows  ;  and  so  it  no  doubt  will 
be  until  it  comes  to  pass,  if  it  ever  shall  come  to  pass,  that  all  her 
secrets  are  won  from  nature,  and  no  dark  place  is  left  in  which 
superstition  can  lurk. 

I.  Secondly,  there  are  the  impostors  who  impose  upon  them- 
selves as  well  as  upon  others ;  whose  self-deception  is  in  truth 
the  main  factor  of  their  success  in  imposing  upon  others.  It 
has  nev-er  been  sufficiently  taken  into  account,  I  think,  that 
deception  is  not  a  constant  but  a  variable  quantity,  and  that 
there  are  manifold  gradations  between  the  most  deliberate  and 
wilful  deceit  on  the  one  hand  and  on  the  other  hand  a  deception 
which  is  unconscious  and  innocent.  One  of  the  arguments 
upon  which  believers  in  the  miraculous  perceptions  of  the 
hypnotic  lay  the  greatest  stress  is  that  they  are  exhibited  and 
attested  sometimes  by  persons  whom  they  know  to  be  utterly 
incapable  of   fraud  and  on  whose  sincerity  and  veracity  they 


II.]       HYPNOTISM,  SOxMNAMBULISM,  AND  ALLIED  STATES.      65 

would  hazard  all  that  they  possess.     Agreeing  with  them  as  to 
the  sincerity,  one  may  still  properly  call  in  question  the  com- 
petence, of  the  witness,  who  may  speak  the  truth  as  he  knows 
it,  without  thinking  the  truth  as  it  is ;  for  the  question  is  not 
merely  whether  he  is  deceiving  us,  but  whether  he  is  himself 
deceived.     His  consciousness,  no  doubt,  testifies  truly  as  to  its 
own  states;  but  it  may  not  testify  truly  as  to  the   causes  of 
them.    It  is  not  amiss  to  reflect  when  w^eighing  beliefs  that  belief 
is  very  much  a  matter  of  temperament,  and  that  there  are  persons 
of  a  certain  temperament  who  are  prone  to  believe  anything  that 
has   passed  vividly  through   their   imaginations  without   con- 
sidering sufficiently  how  it  came  there ;  solemn  asseveration  of 
a  fact  by  them  meaning  no  more  than  a  conviction  of  a  vivid 
mental   experience.      The  temperaments   of  such  persons   are 
unstable  in  this  respect — that  the  members  of  that  congeries  of 
supreme  nerve-centres  which  constitute  the  cerebral  convolutions 
are  not  bound  together  in  compact  communion  of  function,  but 
are  apt  easily  to  take  on  in-coordinate  action,  not  perhaps  of  an 
actually  incoherent  kind,   although  that  is  a   further  stage   of 
degeneration,  but  of  too  isolated  and  independent  a  character. 
Thus  it  comes  to  pass  that  wdien  a  vivid  conviction  takes  hold 
of  the  mind  it  vibrates  there  intensely,  and  does  not  feel  the 
controlling    and   modifying   influences,   consciously   or   uncon- 
sciously working,  of   the  neighbouring  mental   elements   with 
which  it  is  in  physiological  union ;  nay,  it  may  even  inhibit  tem- 
porarily their  functions  altogether.     It  becomes  then  an  intense 
belief  which  is  never  properly  tested  and  corrected  by  sound 
observation  and  sober  reflection.     To  say  that  the  great  majority 
of  men  reason  in  the  true  sense  of  the  word  is  the  greatest  non- 
sense in  the  world ;  they  get  their  beliefs,  as  they  do  their  instincts 
and  their  habits,   as  a  part  of  their  inherited  constitution,   of 
their  education,  and  of  the  routine  of  their  lives. 

It  is  evident  that  this  sort  of  temperament  lends  itself  easily 
to  self-deception.  If  an  idea  reach  that  persistent  and  exclusive 
action  wdiich  entails  an  inhibition  of  the  functions  of  the  other 
ideational  centres,  as  it  notably  does  in  the  hj'pnotic  and  its  allied 
states,  it  is  plain  that  when  the  person  comes  out  of  the  exclusive 
state  of  consciousness  he  or  she  may  be  oblivious  of  what  was 


66  PATHOLOGY  OF  MIND.  [cdap. 

thought  or  done  when  in  it,  and  so  may,  with  perfect  sincerity, 
deny  iiis  or  her  deeds  and  misdeeds,  or  assert  them  to  have  been 
inspired  and  directed  by  some  power  more  than  natural. 
Alienated  for  the  time  being  from  his  fall  self,  he  feels  tlie 
alienated  self  to  have  been  a  strange  or  another  self,  and  cannot 
realise  responsibility  for  its  doings,  even  if  he  remembers  them. 
Between  the  abnormal  state  of  consciousness  which  belongs  to 
the  hypnotic  state  and  the  state  of  consciousness  which  accom- 
panies the  most  deliberate  deception  there  are  transitional 
grades,  whence  the  manifold  gradations  that  are  actually  met 
with  between  wilful  deception  and  innocent  self-deception,  and 
the  reason  why  persons  whose  sincerity  their  friends  recoil  from 
suspecting  do  nevertheless  dupe  themselves  and  others  of  sym- 
pathetic temperament  in  the  grossest  manner.  Just  as  the  string 
of  a  harp  vibrates  to  and  gives  back  the  note  that  is  in  unison 
with  it,  so  the  dupe  vibrates  to  and  gives  back  the  note  which 
the  impostor  strikes. 

c.  It  is  certain  that  a  large,  though  not  certain  how  large,  a 
margin  for  error  should  be  allow^ed  to  defective  observation  in 
these  matters.  True  observation  comes  not  by  instinct,  but  is 
gained  painfully  by  training.  Were  a  list  made  of  the  common 
fallacies  to  wdiich  observation  is  liable,  and  to  each  one  assigned 
its  proper  share  in  these  wonderful  phenomena,  there  would  be 
little  left  unallotted  to  dispute  about.  It  is  a  well-known 
tendency  of  the  human  mind,  which  has  been  the  foundation  of 
the  credit  of  prophets  in  all  ages,  to  be  impressed  strongly  by 
agreeing  instances,  and  to  overlook  or  neglect  disagreeing  or 
opposing  instances.  When  the  mesmeric  subject  makes  a  hit 
the  effect  is  startling  and  the  admiration  unbounded,  while  his 
manifold  failures  are  ignored  and  forgotten,  or  attributed  to 
the  unfavourable  conditions  of  the  experiment.  Moreover,  the 
observation  of  a  particular  experiment  is  commonly  partial  and 
defective,  the  observer  seeing  an  effect  which  strikes  his  atten- 
tion and  overlooking  the  essential  conditions  on  which  it 
depended :  he  may,  as  he  earnestly  asserts,  have  seen  the  thing 
with  his  own  eyes,  but  what  we  require  to  have  noticed  are  the 
various  cooperating  conditions  or  coefficients  which  he  did  not 
see  and  take  notice  of,  and  which  a  cooler,  more  wary  and  skilful 


II.]      HYPNOTIS.M,  SOMNAMBULISM,  AND  ALLIED  STATES.       G7 

observer  would  liave  seen,  noted,  and  weighed.  It  is  beyond  ques- 
tion, as  Voltaire  truly  remarks,  that  magic  words  and  ceremonies 
are  quite  capable  of  most  eflectually  destroying  a  whole  flock  of 
sheep,  if  the  words  be  accompanied  by  a  sufficient  quantity  of 
arsenic.  The  proper  answer  to  the  person  who  has  seen  miracles 
is  certainly  in  nine  cases  out  of  ten  a  direct  declaration  that  not 
the  least  reliance  can  be  placed  upon  his  observing  powers,  and 
a  blank  refusal  to  discuss  his  observations ;  for  life  is  too  short 
to  permit  the  waste  of  time  which  would  be  required  in  order 
to  teach  the  alphabet  of  observation  and  reasoning  to  each 
new-comer. 

Obviously  persons  of  the  neurotic  temperament  described  will 
be  most  liable  to  this  sort  of  defective  observation.  Possessed 
vividly  with  an  idea,  the  faculties  of  their  minds  are  benumbed 
or  suspended :  they  can  see  only  what  is  in  relation  with  the 
predominant  idea.  It  is  notorious  that  the  observer  who  starts 
with  a  preconceived  idea  or  with  a  strong  desire  is  so  far  dis- 
qualified rather  than  qualified  for  his  work;  for  although  his 
special  observation  may  be  sharpened  by  the  idea  or  the  desire 
to  see  what  is  agreeable  to  it,  his  general  powers  are  blunted,  and 
he  is  very  likely  to  be  deluded  ;  but  these  neurotics  are  particu- 
larly liable  to  be  dupes  of  a  partial  observation,  because  of  that 
easily  induced  solution  of  continuity  of  functions  by  which  an 
idea,  when  unusually  active,  escapes  from  the  restraints  and 
corrections  of  the  communion  of  nerve-centres  of  which  its 
centre  is  a  member.  These  considerations  teach  how  gradational 
is  the  transition  from  the  simplest  instances  of  defective  obser- 
vation, such  as  are  continually  exhibited  by  all  men,  to  the 
extreme  instances  of  entire  incapacity  of  observation  which  the 
mesmeric  or  somnambulistic  subject  displays.  K'ot  to  sufier 
any  present  mental  state  to  reach  an  inordinate  activity,  but  to 
maintain  a  free  play  of  all  the  various  chords  of  association 
which  a  wise  culture  has  made  as  many  and  complete  as  pos- 
sible, and  so  to  preserve  the  sound  balance  of  the  judgment, 
is  the  mark  of  a  lars^e  and  well-trained  intellect. 

d.  It  may  be  alleged  that,  after  making  full  allowance  for  de- 
ception and  for  errors  of  observation,  there  is  still  an  unexplained 
residuum  of  the  wonderful  in  the  foresiglit  disj)layed  by  some 


68  PATHOLOGY  OF  MIND.  [chap. 

of  these  mesmeric  subjects.  They  have  predicted  clearly,  it  is 
said,  a  disease  from  which  they  themselves  would  suffer,  and 
eventually  did  suffer,  although  there  was  not  the  least  sign  of  the 
disease  at  the  time  when  they  foretold  it.  If  this  were  true,  and 
the  coincidence  were  not  accidental,  it  may  be  supposed,  before 
acknowledging  a  supernatural  event,  that  a  heightened  sensibility 
had  rendered  them  more  susceptible  to  the  earliest  indications 
of  disease — its  mute  premonitions,  so  to  speak — than  they  were 
in  their  normal  state  of  consciousness,  just  as  a  person  will  feel 
a  sensation  when  his  attention  is  free  which  passes  unnoticed 
when  he  is  actively  emploj^ed.  Or,  if  that  explanation  is  not 
accepted,  it  may  be  supposed  that  the  disease  occurred  as  the 
result  of  a  fixed  idea  in  a  sensitive  mind  that  it  would  occur,  the 
prophecy  having  fulfilled  itself,  not  otherwise  than  as  the  idea 
of  gaping,  of  pain,  of  paralysis,  of  convulsions,  will  sometimes 
induce  gaping,  pain,  paralysis,  convulsions.  It  cannot  be  too 
clearly  apprehended  that  there  is  a  sort  of  innate  tendency  to 
mimicry  in  the  nervous  system :  one  observes  the  most  striking 
manifestations  of  it  in  apes  and  in  children,  and  less  striking 
instances  of  it  in  the  way  in  which  a  person  oftentimes  adopts 
unconsciously  some  of  the  tricks  of  manner  or  of  expression  of 
another  with  whom  he  associates ;  and  certainly  the  simulation 
or  mimicry  of  disease  by  so-called  nervous  or  hysterical  persons 
is  common.  As  in  such  persons  the  idea  of  a  particular  disease, 
if  it  takes  hold  of  them,  will  be  likely  to  reach  that  prepon- 
derating and  persistent  activity  when  it  cannot  be  moderated  by 
reflection,  which  it  inhibits,  it  may  be  expected  to  act  with  excep- 
tional power  upon  the  organic  functions,  if  its  energy  takes  that 
channel,  just  as  the  exclusive  idea  of  the  hypnotic  subject  when 
it  has  a  motor  outlet  nerves  him  to  a  feat  of  muscular  strength 
or  skill  of  which  he  is  incapable  in  his  normal  state. 

c.  AVhen  the  artificial  somnambulist  succeeds  in  reading  what 
is  in  the  mind  of  another  person  who  utters  not  a  word  of  what 
he  is  thinking,  as  is  sometimes  the  case,  his  success  is  due  in 
the  main  to  an  acute  apprehension  of  slight  outward  indications 
of  his  thought,  which  the  person  may  be  entirely  unconscious 
that  he  is  exhibiting ;  the  proof  of  this  being  that  the  experi- 
ment fails  when  it  is  tried  with  one  who,  being  incredulous, 


II.]       HYPNOTISM,  SOMNAMBULISM,  AND  ALLIED  STATES.       G9 

carefully  suppresses  the  least  expression  of  what  is  in  his 
mind,  or  of  set  purpose  puts  on  a  different  expression  of  features. 
There  are  very  few  persons  who  are  skilful  enough  to  prevent 
their  thoughts  and  feelincjs  affectinsj  their  movements.     Let  it 

O  CO 

be  considered  how  quickly  children  and  animals  read  our  moods 
of  mind  in  our  faces,  and  what  acute  perceptions  of  the  motions 
of  a  speaker's  lips  a  deaf  and  dumb  person  is  trained  to  attain, 
so  that  he  can  understand  the  mute  motions  as  well  almost  as  if 
he  heard  the  words  spoken,  and  it  will  appear  probable  that  a 
vivid  thought  may  manifest  itself  unconsciously  in  slight  move- 
ments of  lips  or  features  which,  unperceived  by  an  ordinary 
observer,  do  not  escape  the  acute  apprehension  of  the  so-called 
sensitive.  This  is  without  doubt  the  explanation  of  the  so- 
called  muscle-reading  which  has  lately  attracted  notice.  I  am 
not  sure,  however,  that  the  knowledge  is  not  obtained  in  some 
of  these  cases  without  the  conscious  agency  of  the  subject — to 
wit,  by  an  unconscious  imitation  of  the  attitude  and  expression 
of  the  person,  whose  exact  muscular  contractions  are  instinct- 
ively copied  ;  the  result  being  that,  by  virtue  of  a  well-known 
law,  the  same  ideas  and  feelings  of  which  the  muscular  contrac- 
tions are  the  proper  language,  are  aroused  in  the  subject's  mind. 

Another  explanation,  but  a  fanciful  one,  may  possibly  be  true 
of  occasional  instances  of  success.  They  may  be  owing  to  the 
sympathy  of  similar  constitutions  under  the  same  external  con- 
ditions whereby  their  thoughts  and  feelings  chime,  the  two 
natures  striking  the  same  notes  independently,  like  two  clocks 
striking  the  same  hour  at  the  same  time.  Before  rejecting  the 
hypothesis,  let  it  be  fairly  considered  that  there  are  a  great  many 
persons  who  are  pretty  nearly  automatic  repetitions  of  one 
another  so  far  as  resjards   the   ranc^e    and   character   of   their 

o  o 

thoughts;  they  think  the  same  thoughts  just  as  all  parrots  and 
children  constantly  make  the  same  noises  and  go  through  the 
same  performances  without  imitating  one  another ;  and  when  they 
are  under  the  same  external  conditions,  when  their  feelinsjs  are 
attuned  to  the  same  note,  when  their  minds  are  acted  upon  by 
the  same  suggestions,  as  is  the  case  where  both  are  engaged  in 
one  experiment,  it  is  not  perhaps  to  be  wondered  at  that  there 
should  be  an  independent   chiming   of  thoughts  and  feelings 


70  PATHOLOGY  OF  MIND.  [chap. 

occasionally.  Two  such  persons  would  probably  make  tlie  same 
movements  in  order  to  escape  if  they  were  exposed  together 
suddenly  to  a  common  pressing  danger,  without  consulting  with 
one  another ;  and  I  doubt  not  that  a  young  man  and  maiden, 
when  they  fall  in  love  with  one  another,  naturally  think  the 
thoughts,  feel  the  sensations  and  emotions,  and  do  the  things 
which  young  men  and  maidens  have  always  thought  and  felt  and 
done  in  similar  circumstances,  without  having  to  learn  their 
lesson  either  from  one  another  or  from  any  one  else.  The 
Siamese  twins  who,  being  bodily  bound  together,  perforce  lived 
under  the  same  conditions,  were  united  in  a  close  mental 
sympathy  for  a  great  part  of  their  lives  ;  they  generally  had  the 
same  thoughts  at  the  same  moments,  made  the  same  resolves  and 
did  the  same  things  without  previous  communication  with  one 
another ;  unfortunately  the  happy  harmony  did  not  last,  for  one 
of  them  became  addicted  to  intemperance,  a  vice  which  led  to 
frequent  bickerings  and  disputes,  and  in  the  end  to  an  earnest 
desire  to  be  separated.  The  close  sympathy  of  feeling  and 
thought  sometimes  shown  by  ordinary  twins  is  well  known,  and 
there  are  one  or  two  remarkable  instances  on  record  of  twins  who 
were  attacked  with  the  same  form  of  insanity  at  the  same  time, 
while  several  cases  have  been  recorded  of  brothers  or  of  sisters 
who,  having  lived  much  together  in  the  same  external  conditions, 
have  become  similarly  deranged. 

Another  of  the  intermediate  states  which  bridge  the  gap 
between  the  most  abnormal  and  the  normal  states  of  conscious- 
ness, and  closely  allied  to  the  abnormal  states  already  described, 
is  ecstasy  or  trance.  This  ecstasy  is  a  condition  into  which  the 
enthusiast  of  every  religion,  Buddhist,  Brahmin,  Christian, 
Mahometan,  has  contrived  to  throw  himself,  and  is  truly,  as 
the  word  means  literally,  a  standing  out  of  himself.  The 
symptoms  are  very  much  alike  in  all  cases  :  after  sustained 
concentration  of  the  attention  on  the  desire  to  attain  to 
an  intimate  communion  with  heavenly  things,  the  self-absorp- 
tion being  aided  perhaps  by  fixing  the  gaze  intently  upon 
some  holy  figure  or  upon  the  aspirant's  own  navel,  the  soul 
is  supposed  to  be  detached  from  the  objects  of  earth,  and 
to  enter  into  direct  converse  with  heaven ;  the  limbs  are  then 


II.]      HYPNOTISM,  SOMNAMBULISM,  AND  ALLIED  STATES.      71 

motionless,  flaccid,  or  fixed  in  the  maintenance  of  some  attitude 
which  has  been  assumed,  general  sensibility  is  blunted  or 
extinguished,  the  special  senses  are  insusceptible  to  the  impres- 
sions which  usually  affect  them,  the  breathing  is  slow  and  feeble, 
the  pulse  is  scarcely  perceptible,  the  eyes  are  perhaps  bright  and 
animated,  and  the  countenance  may  wear  such  a  look  of  rapture, 
the  fashion  of  it  be  so  chancfed,  that  it  seems  to  be  transfifrured 
and  to  shine  with  a  celestial  radiance. 

Ecstasies  of  this  kind  are  much  less  common  nowadays 
than  they  were  in  past  ages,  when  religious  feeling  and  belief 
had  a  more  vital  hold  of  human  thought  and  conduct :  when 
numerous  monasteries  were  scattered  over  the  land ;  when 
austerities  and  asceticism  were  in  vogue  ;  when  prayers, 
penances,  meditations,  and  religious  ceremonies  filled  up  the 
main  business  of  life;  when  a  disunion  from  the  things  of 
earth  and  the  closest  union  with  the  things  of  heaven  was 
set  forth  as  the  end  to  be  perpetually  aimed  at  in  order  to 
escape  everlasting  torment.  However,  as  Maury  has  pointed 
out,  these  trances  in  which  supernatural  communications  took 
place  did  not  befall  saints  only,  for  the  wicked  were  sometimes 
seized  by  them,  and  gave  blasphemous  recitals  of  their  visions. 
Hence  it  became  necessary  to  make  two  classes  of  ecstatics — 
the  holy  and  the  demoniacal,  or,  as  I  might  fitly  call  them, 
theoleptics  and  diaboleptics.  It  would  be  rash  to  venture  to 
say  to  which  class  are  to  be  referred  the  ecstatics  who  from  time 
to  time  are  heard  of  at  the  present  day,  famous  among  whom 
is  Louise  Lateau,  known  as  the  Belgian  stigmatic,  because 
during  her  often-recurring  trances  marks  of  bleeding  from  the 
forehead,  from  the  left  side,  and  from  the  palms  of  the  hands, 
are  seen. 

Obviously  the  ecstatic  state  is  very  much  like  the  hypnotic 
state  both  in  its  mode  of  occurrence  and  in  the  character  of  its 
phenomena.  There  is  such  a  vivid  exaltation  of  a  particular  state 
of  conscionsness  that  sensibility  is  suspended,  voluntary  move- 
ment inhibited,  and  vital  function  itself  lowered.  St.  Theresa 
described  her  state  of  rapture  as  one  in  which  "  the  body  loses  all 
the  use  of  its  voluntary  functions  and  every  part  remains  in  the 
same  posture  without  feeling,  hearing,  or  seeing,  at  least  so  as  to 


72  PATHOLOGY  OF  MIND.  [chap. 

perceive  it."  When  she  had  a  mind  to  resist  these  raptures  "  there 
seemed  to  be  somewhat  of  a  mighty  force  under  my  feet  which 
raised  me  up  that  I  knew  not  what  to  compare  it  to  " ;  in  other 
words,  when  the  energies  of  the  unstable  nerve-centres  were  not 
suffered  to  discharge  themselves  in  the  tension  of  a  particular 
strain  of  consciousness  they  troubled  the  centres  of  muscular 
sensibility,  and  produced  the  motor  hallucination  of  an  eleva- 
tion from  the  ground,  just  as  they  might  on  another  occasion 
have  produced  vertigo.  There  is  not  in  all  cases  an  entire 
insensibility  to  external  impressions ;  like  hypnotics,  these 
ecstatics  are  sometimes  sensible  to  impressions  that  are  in 
relation  with  the  ideas  of  their  visions,  and  then  mix  the  real 
with  the  imaginary ;  they  may  gaze,  for  example,  on  a  crucifix 
on  which  a  Christ  is  suspended  until  they  hear  him  speak  or 
see  him  descend  and  approach  them,  and  they  will  show  them- 
selves conscious  sometimes  of  the  presence  and  of  the  words  of 
one  whose  sacred  character  or  function  suits  the  strain  of  their 
rapture.  But  the  insensibility  to  pain  sometimes  is  very  re- 
markable. Rapt  in  his  gay  vision  of  unreal  bliss,  the  religious 
fanatic  of  India  is  indifferent  to  the  wounds  and  injuries  that 
are  inflicted  upon  him  and  will,  without  wincing  in  the  least, 
suffer  his  body  to  be  toriured  in  a  way  that  must,  were  he  in  a 
normal  state  of  consciousness,  produce  intolerable  pain.  The 
natives  of  India  and  all  primitive  races  are  more  susceptible  to 
these  trance-like  states  than  are  Europeans,  as  was  shown  by 
numerous  experiments  to  perform  surgical  operations  on  persons 
put  into  the  mesmeric  state ;  for  while  it  was  easy  to  throw  the 
natives  into  the  proper  state  of  insensibility  for  the  operation, 
the  experiment  was  usually  unsuccessful  with  the  European 
soldier.  Among  the  North  American  Indians  it  was  the  custom 
to  tie  the  prisoner  of  war  to  a  stake  before  he  was  executed  and 
to  subject  him  for  several  hours  to  all  the  means  of  torture  which 
savage  ingenuity  and  ferocity  could  devise,  "women  and  children 
joining  with  eager  delight  and  acclamation  in  the  cruelties 
practised  upon  the  victim.  He,  meanwhile,  scornful  of  their 
impotent  efforts  and  disdaining  to  show  the  least  sign  of  pain, 
defied  his  tormenters  with  the  bitterest  irony  and  the  most  in- 
sulting sarcasm,  boasting  exultantly  how  many  of  their  kindred 


II.]       HYPNOTISM,  SOMNAMBULISM,  AND  ALLIED  STATES.       73 

he  had  slain,  how  horribly  he  had  tortured  them,  and  jeering 
them  contemptuously  for  their  futile  attempts  to  make  him 
suffer.  His  transport  of  mental  exaltation  made  futile  their 
hellish  efforts.  I  doubt  not  that  the  Christian  martyr,  in  a  like 
condition  of  mental  exaltation,  has  sometimes  borne  the  flames 
of  the  stake,  when  burned  to  death,  or  the  other  tortures  under 
which  he  has  expired,  with  an  indifference  and  a  composure  that 
seemed  to  onlookers  the  proof  of  a  supernatural  support.  "When 
one  thinks  of  the  fearful  record  of  man's  inhumanity  to  man 
which  human  history  is,  it  seems  a  happy  thing  that  there  has 
been  mercy  enough  in  the  dispensation  to  put  bounds  to  the 
power  of  human  malignity  to  inflict  torture,  whereby  achieve- 
ment has  fallen  so  far  short  of  desire — first,  in  the  limit  which 
there  is  to  man's  capacity  to  suffer,  whereby  pain  itself  kills, 
and,  secondly,  in  the  power  of  enthusiasm  to  defy  torture. 
The  dancing  manias  of  the  middle  ages,  the  so-called  con- 
vulsionists  of  St.  Medard,  and  similar  mental  epidemics  in 
which  an  infection  of  enthusiasm  spread  through  persons  placed 
in  the  same  conditions,  have  furnished  many  instances  of 
general  insensibility  to  violent  blows  and  to  other  severe 
handlings  while  the  mind  was  rapt  in  the  ecstasy  of  the 
particular  excitement.  The  only  remark  which  it  remains  to 
make  concerning  these  ecstatics  is  that  while  they  oftentimes 
remember  what  has  happened  during  their  visions  and  angelic 
communions  they  sometimes,  like  somnambulists,  have  only 
a  confused  remembrance  or  no  remembrance  at  all;  their 
experience  cannot  be  recalled  and  described,  for,  as  they  imagine 
and  declare,  it  was  of  such  a  character  as  to  transcend  ordinary 
thought  and  expression,  truly  ineffable. 

A  disease  which  is  closely  allied  to  the  abnormal  states  de- 
scribed, holding  an  intermediate  place  between  them  and  epilepsy, 
is  catalepsy.  The  person  who  is  subject  to  cataleptic  attacks 
falls  suddenly  into  a  state  of  seeming  unconsciousness,  but  does 
not  fall  down  ;  he  maintains  the  attitude  in  which  he  was  at 
the  time  when  he  was  seized,  just  as  if  he  had  been  thrown 
suddenly  into  the  brownest  of  "  brown  studies,"  continuing  to 
stand  if  he  was  standing,  to  sit  if  he  was  sitting,  to  kneel  if  he 
"was  kneeling.     The  act  he  was  doing  is  suspended  midway  in 


74  PATHOLOGY  OF  MIND.  [chap. 

its  execution.  To  all  appearance  lie  is  little  more  than  a  half- 
animated  statue  while  the  paroxysm  lasts.  He  seems  partially 
or  completely  insensible  to  external  impressions,  and  when  his 
arm  or  any  other  part  of  the  body  is  put  into  a  certain  position 
that  position  is  retained  for  an  indefinite  time,  or  until  he  comes 
to  himself  again.  The  pulse  is  usually  more  feeble  and  the 
respiration  more  slow  than  in  the  natural  state.  The  fit  may 
last  for  a  few  minutes  only,  or  for  a  few  hours,  occasionally  for 
a  yet  longer  period,  and  when  it  is  over  there  is  no  memory  of 
what  has  happened  during  it.  No  particular  mental  state, 
voluntary  or  involuntary,  seems  to  have  anything  to  do  with  the 
induction  of  the  cataleptic  state,  although  it  is  probable  enough 
that  a  moral  shock  might  be  the  occasion  of  an  attack  in  one 
who  was  subject  to  the  disease ;  it  has  occurred  where  there  was  no 
reason  to  suspect  actual  disease  of  the  brain,  and  it  has  occurred 
where  there  was  grave  organic  disease  thereof;  but  concerning 
the  actual  conditions  of  its  occurrence  we  know  nothing. 

I  go  on  now  to  direct  particular  attention  to  the  strange 
abnormal  states  of  consciousness  that  are  sometimes  witnessed 
in  persons  who  suffer  from  epilepsy.  It  is  well  known  that  one 
who  is  a  victim  of  that  form  of  epilepsy  which  is  called  le  petit 
mal  will  sometimes,  during  the  temporary  suspension  of  con- 
sciousness, continue  without  interruption  the  mechanical  work 
which  he  was  doing  at  the  moment  when  he  was  seized — will  go 
on  walking  if  he  was  walking,  sewing  if  he  is  a  tailor  who  was 
occupied  in  sewing,  playing  on  the  violin  if  he  is  a  musician  who 
was  so  employed.  It  has  furthermore  been  observed  that  the 
suspension  of  ordinary  consciousness  may  be  more  than  mo- 
mentary in  certain  so-called  masked  epileptic  states,  and  that 
during  its  suspension  the  person,  to  onlookers  appearing  as  if  he 
were  conscious  of  what  he  was  doing,  may  go  through  a  train 
of  new  and  more  or  less  coherent  acts  which  when  he  comes  to 
his  natural  self  he  is  unconscious  of  having  done.  Like  the 
somnambulist,  he  has  been  in  an  abnormal  state  of  conscious- 
ness, during  which  he  acted  as  if  he  were  another  being,  knowing 
not  what  he  did,  or,  if  he  did  know  it  at  the  time,  not  re- 
membering it  afterwards.  But  it  is  most  probable  that  he  did 
not  know  it ;  for  what  he  does,  although  it  may  have  method  in 


iL]       Hi'PNOTiSM,  SOMNAMBULISM,  AND  ALLIED  STATES.       75 

it,  is  commonly  inappropriate  and  foolish,  and  nowise  called  for 
by  the  external  conditions  of  his  surroundings,  of  which  he 
seems  unconscious. 

On  one  occasion  I  was  consulted  by  a  gentleman,  aged 
twenty-three,  of  good  muscular  development,  brisk  intelligence, 
and  unusual  energy  of  character,  who  had  for  some  time 
worked  very  hard  at  a  business  which  involved  considerable 
strain  and  excitement.  For  five  years  he  had  suffered  from 
epileptic  or  quasi-e]3ileptic  attacks  ;  at  first  he  had  fallen  down 
in  them  in  the  ordinary  way,  but  after  a  time  they  came 
on  with  a  feeling  of  trembling  and  of  loss  of  power  in  the 
knees,  immediately  upon  which  the  unconscious  state  supervened, 
but  he  did  not  fall  dow^n  ;  on  the  contrary,  while  this  abnormal 
state  lasted,  which  it  did  for  an  hour  usually,  and  sometimes  for 
hours,  he  did  strange  acts,  not  knowing  what  he  was  doing,  or  if 
he  w^as  in  the  street  went  along  in  such  a  dazed  and  uncertain 
way  that  the  police,  thinking  him  drunk,  interfered  with  him. 
A  few  days  before  his  visit  to  me  he  had  had  an  attack  in  the 
street,  and  he  remembered  nothing  w^hatever  of  what  occurred 
from  the  beginning  of  it  until  he  found  himself  in  his  office 
to  which  a  friend  who  had  seen  him,  and  recognised  his 
plight,  had  conducted  him.  From  another  friend  who  resided 
with  him  I  learned  that  when  he  was  in  the  attacks  he  seemed 
to  be  partly  aware  that  he  was  not  w^ell,  told  them  what  should 
be  done  to  him,  and  spoke  of  whatever  might  be  in  his  mind, 
not  always  quite  coherently,  but  usually  tolerably  so.  On  two 
occasions  he  had  been  restive,  as  if  he  wished  to  get  away ;  once 
he  had  behaved  as  if  he  were  going  to  be  drowned,  and  at  another 
time  he  had  acted  as  if  he  w^ere  going  to  get  up  the  chimney. 
Before  or  after  the  attacks  he  suffered  from  bad  headaches, 
wdiich  were  formerly  so  severe  as  to  compel  him  to  lie  down 
wherever  he  chanced  to  be  until  they  passed  off^  but  the  pain 
had  not  been  so  severe  lately.  The  immediate  occasion  of  his 
visit  to  me  was  a  great  nervousness  which  had  come  upon  him ; 
he  was  apprehensive  of  going  about  alone  or  of  sleeping  alone, 
and  was  much  distressed  by  absurd  impulses  which  tormented 
him  and  which  he  could  hardly  control,  although  he  knew  very 
well  how  absurd  they  were,  and  tried  hard  to  laugh  himself  out 


76  PATHOLOGY  OF  MIND.  [chap. 

of  them.  Of  late  the  impulse  to  get  up  the  chimney  hfid 
tormented  him  for  no  reason  whatever,  and  it  had  grown  so 
strong  that  sometimes  he  had  the  greatest  mental  struggle  to 
prevent  himself  from  yielding  to  it.  Other  morbid  impulses 
had  afflicted  him :  at  one  time  he  had  felt  impelled  to  drown 
himself  in  the  washhand  basin,  and  at  another  time  to  throw 
himself  in  front  of  a  railway  train  when  he  saw  one  approach- 
ing; when  one  impulse  left  him  another  took  its  place.  From 
time  to  time  a  black  curtain  or  cloud  seems  to  fall  before  his 
eyes,  is  accompanied  by  a  peculiar  sensation  or  pain  in  the  head, 
and  for  the  moment  he  is  scarcely  conscious ;  but  the  attack, 
wdiicli  is  doubtless  of  an  epileptic  nature,  quickly  passes  off. 
The  morbid  impulses  which  reason  inhibits  with  difficulty  no 
doubt  mark  a  condition  of  nerve-centres  of  the  same  kind  as, 
but  less  morbid  in  degree  than,  that  which  exists  when  reason 
and  will  are  entirely  suspended  and  the  persistence  of  conscious- 
ness even  is  doubtful. 

I  forbear  to  quote  other  similar  cases  in  which  odd,  stupid, 
and  even  dangerous  acts  have  been  done  during  the  epileptic 
suspension  of  normal  consciousness,  or  to  attempt  a  speculative 
explanation  of  them.  To  call  the  person's  conduct  during  the 
paroxysms  automatic  does  not  help  us  much  to  understand  it ; 
it  is  so  like  much  of  his  conduct  when  he  is  not  in  a  paroxysm 
that  one  is  inclined  to  ask  whether  that  is  not  automatic  also. 
Plainly  his  state  is  most  lil^e  an  acted  dream,  and  bears  out  the 
sagacious  opinion  of  old  medical  writers  that  there  is  a  kinship 
between  somnambulism  and  epilepsy ;  a  kinship  which  reaches 
not  merely  to  a  resemblance  of  phenomena,  but  has  a  deeper 
basis  in  a  common  neurotic  temperament.  In  truth  all  these 
lepsies  or  peculiar  nerve -seizures — epilepsy,  catalepsy,  theolepsy, 
and  somnambulism,  betray  in  most  cases  a  neurotic  inheritance, 
and  may  justly  be  suspected  to  be  very  likely  to  leave  a  neurotic 
legacy.  By  bringing  them  together,  as  I  have  done  in  this 
chapter,  it  has  been  shown  that  the  most  extreme  and  abnormal 
instances  of  double  consciousness  are  not  so  widely  separated 
from  states  of  normal  consciousness  as  they  appear  to  be  at  first 
sight,  and  that  we  may,  if  we  will,  pass  from  one  extreme  to 
the  other  over  a  bridge  of  many  arches.     It  is  certainly  impos- 


n.J      IIYP^s'OTiSM,  SOMNAMBULISM,  AND  ALLIED  STATES.       77 

sible  to  realise  the  state  of  mind  of  a  person  who  is  in  one  of 
these  states  of  abnormal  consciousness;  conscious  one's  self  or 
unconscious,  one  cannot  form  accurate  conceptions  of  the  inter- 
mediate anomalous  states ;  but  the  experience  of  a  person  who, 
when  takinsj  chloroform  in  order  to  be  rendered  insensible, 
struggles,  kicks,  shouts  in  a  sort  of  nightmare  after  he  has 
ceased  to  see  or  hear,  but  before  he  is  completely  passive  and 
insensible  to  external  constraint,  feeling  it  but  not  in  the  least 
realising  its  true  nature,  may  convey  an  imperfect  idea  of  the 
quasi-unconscious  state  of  the  epileptic  who  does  strange  things 
tliat  he  wots  not  of.  The  main  features  wdiich  the  abnormal 
states  present  in  common  are :  first,  that  coincident  with  a 
partial  mental  activity  there  is  more  or  less  inhibition,  which 
may  bo  complete,  of  all  other  mental  function ;  secondly,  that 
the  individual  in  such  condition  of  limited  mental  activity  is 
susceptible  only  to  impressions  wdiich  are  in  relation  with  its 
character  and  are  consequently  assimilated  by  it ;  and,  thirdly, 
that  when  he  comes  out  of  his  abnormal  state  he  may  have  only 
the  most  dim  and  hazy  remembrance  of  what  happened  when 
he  was  in  it,  or  may  not  remember  it  in  the  least. 

If  any  one  will  be  at  the  pains  to  examine  the  phenomena 
of  the  modern  epidemic  of  superstition  wdiich  is  known  as 
spiritualism  by  the  light  of  the  foregoing  exposition,  he  will  be 
able  to  weigh  at  its  true  value  much  of  what  seems  to  be  the  in- 
contestable evidence  of  eye-witnesses  who  vouch  for  miraculous 
phenomena.  A  great  proportion  of  them  are  undoubtedly  the 
work  of  impostors  consciously  duping  their  victims,  who,  pre- 
disposed by  temperament  and  a  w^ant  of  training  in  observation 
to  believe  the  w^onderful,  are  an  easy  prey.  If  the  performer  is 
skilful  by  reason  of  natural  aptitude  and  long  practice,  he 
may  easily,  like  a  conjuror,  frustrate  the  attempts  of  even 
a  good  observer  to  detect  his  mode  of  operation.  We  are 
unable  to  discover  how  the  conjuror  does  his  tricks,  although 
we  know  them  to  be  tricks,  partly  because  he  is  clever  enough 
to  distract  attention  in  some  way  from  what  he  is  doing  at 
the  critical  moment  of  the  feat,  and  partly  also  probably 
because  a  muscular  act  may  be  quicker  than  perception — so 
quick,  in  fact,  as  to  be  imperceptible,  as  the  twinkling  of  an  eye, 


78  PATHOLOGY  OF  MIND.  [chap. 

which  is  a  muscidar  act,  commonly  is.  Then  there  are  the 
unconscious  impostors  Avho,  lilce  the  hypnotics,  get  their  minds 
into  a  sort  of  convulsive  activity  of  certain  ideas  with  a 
temporary  paralysis  of  all  other  ideas,  and  are  unconscious 
themselves  of  the  fraud  which  they  are  practising,  or  at  any  rate, 
like  one  in  a  dream,  morally  insensible  to  the  guilt  of  it. 

The  extraordinary  revelations  of  names,  of  events,  and   the 
like,   which   the   "medium"    makes   sometimes    under   spirit- 
guidance,  and  which  it  is  supposed  could  not  possibly  have  been 
known  in  any  natural  way,  are  of  the  same  nature  as  the  similar 
wonders  of  the  mesmeric  trance.     A  heightened  sensibility  of  a 
particular  sense,  giving  information  which  it  could  not  have 
given  in  its  ordinary  state,  will  account  for  some  extraordinary 
perceptions ;  a  revival  in  memory  of  forgotten  facts  which  the 
individual  himself  may  not  remember  that  he  had  ever  known, 
such  as  notably  occurs  sometimes  in  dreams,  will  furnish  the  key 
sometimes  to  knowledge  which  looks  marvellous  to  onlookers ; 
an  increased  muscular  power  owing  to  the  concentration  of  the 
whole  nervous  energy  upon  an  act,  and  to  the  full  faith  that  he 
can  do  it,  may  enable  the  medium  to  perform  a  feat  of  strength 
or  of  skill  which  he  would  not  find  it  easy  to  do  in  his  natural 
state,  when  some  distraction  would  prevent  the  fulness  and  mar 
the  unity  of  the  effect.     Of  course  if  it  be  true,  as  the  spiritual- 
ists allege,  that  a  table  will  rise  from  the  floor  and  float  about 
the  room  when  the  medium  neither  touches  it  nor  has  any  sort 
of  physical  connection  with  it,    another  explanation   must  be 
sought  for.     One  may  venture  to  conclude  in  accordance  with 
experience  of  known  phenomena  that  the  person  who  sees  a 
table  float  through  the  air,  or  feels  it  rise  from  the  ground  when 
his  hands  are  placed  upon  it,  is  laboimng  under  a  motor  hallu- 
cination of  eye  or  of  touch,  a  sort  of  hallucination  which  it  is 
easier  to  have  than  most   persons  think.     Possessed  with  the 
expectant  idea  that  a  movement  will  take  place,  he  has  the 
vivid  motor  intuition  or  mental  presentation  of  that  movement 
stirred  into  activity,  and  the  motor  intuition,  which  has  been 
thus   excited   subjectively,  is  projected  objectively  and  takes 
sensible  form  as  an  actual  movement,  not  otherwise  than  as 
a  giddy  person  sees  the  room  turn  round:  it  is  the  objective 


II.]      HYPNOTISM,  SOMNAMBULISM,  AND  ALLIED  STATES.       79 

aspect  of  liis  subjective  state.  If  he  conceive  the  idea  of  a 
rising  or  of  a  floating  table  so  vividly  that  it  excites  the  corre- 
sponding motor  intuition  to  the  pitch  of  hallucination,  it  is 
impossible  he  should  not  actually  feel  or  see  the  movement;  no 
wonder  therefore  he  asserts  solemnly  that  he  saw  it  with  his 
own  eyes.  As  I  have  pointed  out  already,  many  saints  are 
alleged  on  the  testimony  of  eye-witnesses  to  have  floated  in  the 
air,  among  whom  may  be  mentioned  St.  Philip  Neri,  St.  Dunstan, 
St.  Christina,  and  lastly  St.  Seraphina,  a  nun  in  whom  the 
tendency  to  rise  was  so  great  that  six  nuns  could  not  hold 
lier  down.  These  flights  took  place  during  the  raptures  or 
ecstasies  into  which  these  holy  persons  fell ;  and  it  will  hardly 
be  doubted  by  those  who  class  the  phenomena  scientifically 
with  the  rides  of  witches  through  the  air  that  some  of  the 
saints  had  the  conviction,  which  persons  in  dreams  have  some- 
times, that  they  did  actually  float  in  the  air  during  their 
ecstasies.  What  then  with  the  motor  hallucinations  of  the 
saints  themselves,  and  what  with  the  motor  hallucinations  of 
the  admiring  observers  who,  being  not  of  little  faith,  did  not 
doubt,  there  is  quite  enough  to  account  for  the  stories  of  the 
flights,  without  appealing  to  supernatural  aid. 

It  has  been  proved  amply  by  experiment,  as  it  might 
have  been  predicted  safely  would  be  the  case,  that  faith  is 
necessary  to  the  manifestation  of  the  phenomena  of  spiritualism; 
the  presence  of  a  sceptic  render^  the  conditions  unpropitious, 
and  nothing  extraordinary  takes  place.  That  has  been  so  with 
miracles  of  all  sorts  from  the  beginning  of  the  world  unto  the 
present  day ;  they  have  chanced  to  occur  in  the  presence  of 
believers  who  were  so  full  of  faith  that  they  needed  not  to  have 
their  faith  strengthened,  and  they  have  not  chanced  to  occur 
in  the  presence  of  unbelievers,  whose  doubts  might  have  been 
dispelled  by  their  most  potent  evidence.  The  spiritualists 
refuse  to  submit  their  marvels  to  the  rigorous  and  critical 
examination  of  sceptics  who  are  competent  to  test  them ;  they 
insist  upon  making  conditions  which  render  satisfactory  inquiry 
impossible  ;  and  when  the  sceptics  refuse  to  be  handicapped  by 
such  conditions,  and  insist  upon  the  same  perfect  freedom  of 
doubt  and  of  experiment  which  they  would  use  in  any  truly 


80  PATHOLOGY  OF  MIND.  [criAP. 

scientific  inquiry,  they  forthwith  charge  them  with  prejudice 
and  a  refusal  to  investigate.  They  appeal  too  to  the  testimony 
of  their  own  witnesses,  who,  being  ardent  believers,  are  quite 
incapable,  notwithstanding  the  best  intentions,  of  observing 
correctly  and  of  detecting  fraud  which  is  not  glaring ;  for  they 
are  like  the  hypnotic  or  the  somnambulist,  who  sees  only  that 
which  is  in  relation  with  his  ideas  and  will  assimilate  with 
them.  Faith  in  things  unseen  and  spiritual  that  are  believed 
to  act  upon  things  seen  and  material  is  incompatible  with  true 
observation  of  things  seen,  for  observation  is  vitiated  funda- 
mentally, and  cannot  be  unbiassed  and  adequate. 

In  concluding  the  chapter  one  thing  may  be  noted  with 
regard  to  spiritualists  :  that  many  of  them,  especially  the  most 
eager  and  intense  among  them,  have  the  neu.rotic  temperament, 
which  goes  along  with  epilepsy  or  insanity  or  other  allied 
nervous  disease  in  the  family.^  I  need  not  repeat  what  I  said 
before  concerning  the  outcome  of  this  temperament  in  belief : 
the  lame,  the  halt,  the  blind,  the  warped  in  intellect,  who  follow^ 
eagerly  dark  by-paths  of  belief,  may  be  gathered  together  into 
one  fold :  their  aberrant  and  fanatic  beliefs,  over  which  reason 
has  no  sway,  betray  tlie  character  of  their  temperaments.  To 
strive  by  argument  to  modify  their  convictions  is  a  vain 
imagination  and  a  futile  labour :  it  is  to  labour  to  argue  away 
a  temperament ;  and  that  is  work  which  a  wise  man  does  not 
undertake. 

"  You  may  as  well 
Forbid  the  sea  for  to  obey  the  mcon 
As  or  by  oath  remove  or  counsel  sliake 
The  fabric  of  his  folly,  ^vhose  foundation  is 
Piled  upon  his  faith,  and  will  continue 
The  standing  of  his  body." 

1  The  London  Dialectical  Society  appointed  a  committee  to  investigate 
the  subject  of  spiritualism.  The  committee  took  the  evidence  of  a  great 
many  spiritualists  and  published  a  report.  However,  "of  the  compara- 
tively small  number  of  persons  who  were  conspicuous  either  as  advocates 
or  'mediums,'  one  became  the  subject  of  well-marked  mental  illness,  and 
another  had  to  be  confined  in  a  lunatic  asylum.  A  third  person,  who  was 
an  eager  member  of  one  of  the  sub-committees,  was  seized  with  a 
mysterious  form  of  paralysis,  although  comparatively  a  young  man.'' — 
Report  on  Spiritualism,  p.  SO. 


II.]      HYPNOTISM,  SOMNAMBULISM,  AND  ALLIED  STATES.      81 


APPENDIX. 

Some  years  ago  there  appeared  in  several  American  journals  the 
leport  of  an  extraordinary  case  of  somnambulism — it  was  that  of  a 
boy  who,  while  in  a  state  of  somnambulism,  had  killed  another  boy. 
But  no  exact  scientific  account  of  it  was  ever  given,  so  far  as  I 
know.  In  April  of  this  year,  however,  an  undoubted  case  of 
somnambulistic  homicide  occurred  in  Glasgow,  the  account  of  which 
has  been  published  since  the  foregoing  chapter  was  written.^  A  man 
named  Fraser,  twenty  eight  years  of  age,  seized  his  child  who  was 
in  bed  with  him,  and  dashed  its  head  against  the  wall  or  floor, 
believing  that  he  had  seized  a  wild  beast  which  had  risen  through 
the  floor  and  jumped  upon  the  bed  to  attack  the  child.  His  wife's 
screams  awoke  him,  and  he  was  horrified  to  find  that  he  had  fatally 
injured  his  child,  whom  he  was  passionately  fond  of. 

He  was  a  pale  and  dejected  looking  man  of  nervous  temperament, 
dull,  and  somewhat  childish,  but  able  to  earn  his  livelihood  as  a 
saw-grinder,  being  a  good  workman.  His  mother  had  suffered 
nearly  all  her  life  from  epileptic  fits,  and  had  died  in  one ;  her 
father,  whom  Eraser  was  said  to  be  very  like,  also  died  in  a  fit. 
His  maternal  aunt  and  her  son  were  both  insane.  His  brother 
died  from  convulsions  in  infancy,  and  his  own  child  had  been 
dangerously  ill  from  convulsions  at  one  time.  There  was,  therefore, 
an  unquestionable  neui'otic  family  history.  From  his  earliest  years 
he  had  himself  been  troubled  by  bad  dreams  and  nightmares,  and 
had  often  walked  in  his  sleep.  He  was  particularly  liable  to  do 
so  after  he  had  undergone  excitement  and  agitation  in  the  day. 
For  example,  having  a  little  sister  whom  he  had  often  warned 
against  falling  into  the  water,  he  got  up  in  his  sleep  several  times 
and  went  down  to  the  water-side,  where  he  called  her  loudly  by 
name,  and  grasped  with  his  arms  as  if  he  were  rescuing  her. 
Sometimes  he  awoke,  but  sometimes  went  back  to  bed  without 
awaking.  He  remembered  nothing  about  these  nocturnal  excursions 
unless  he  was  awakened  at  the  time,  but  suspected  he  had  made 
one,  in  consequence  of  feeling  weary  and  unrefreshed  in  the  morning. 
After  his  marriage  in  1875  the  attacks  assumed  a  different 
^  Jounyxl  of  Mental  Science,  October,  1878. 


82  PATHOLOGY  OF  MIND.  [chap.  n. 

character :  a  great  terror  would  seize  upon  him,  and  he  would  start 
out  of  bed  under  a  vivid  feeling  that  the  house  was  on  fire,  that  his 
child  was  falling  into  a  fit,  that  a  wild  beast  of  some  kind  had  got 
into  the  room  ;  roaring  like  an  animal,  he  would  drag  his  wife  and 
child  out  of  bed  in  order  to  save  them,  or  would  chase  the  supposed 
beast  frantically  through  the  room,  throwing  the  furniture  about, 
and  striking  at  it  with  any  weapon  he  could  lay  hold  of.  He  had 
on  different  occasions  seized  his  wife,  his  father,  a  fellow  lodger  by 
the  throat,  and  nearly  strangled  them,  believing  that  he  had  got 
hold  of  the  beast.  During  the  seizures  his  eyes  were  open  and 
staring  ;  and  it  was  plain  he  saw  and  seized  chairs  or  any  con- 
venient weapon,  albeit  he  was  blind  to  what  was  not  in  relation 
with  his  delusive  ideas ;  sometimes  he  could  hear  and  answer 
questions,  speaking  distinctly,  at  other  times  not. 

It  was  in  one  of  the  attacks  that  he  killed  his  child.  His  wife 
was  awakened  by  hearing  him  roaring  and  furiously  dragging  at 
her  ;.  he  then  leaped  out  of  bed,  and  as  she  followed  him,  as  she 
used  to  do  on  these  occasions,  she  heard  him  smashing  something 
against  the  wall,  which  she  was  horror-struck  to  find  was  the  child ; 
its  skull  was  so  severely  fractured  that  it  soon  died.  Awakened  by 
her  cries,  he  showed  the  utmost  distress,  ran  for  water,  roused  the 
neighbours,  and  hastened  to  fetch  a  doctor.  Put  on  his  trial  for 
murder,  he  was  acquitted  on  the  ground  of  being  unconscious  of 
the  nature  of  his  act  by  reason  of  somnambulism. 

The  case  much  strengthens  the  opinion  of  old  medical  writers 
that  there  is  a  close  affinity  between  somnambulism  and  epilepsy. 
In  truth,  looking  to  the  history  of  epilepsy  in  the  family,  and  to  the 
character  of  the  nocturnal  seizure,  the  latter  might  justly  be  looked 
upon  as  a  nocturnal  epileptic  fit,  in  which  the  discharge  took  a 
mental  instead  of  a  motor  channel,  as  we  know  to  happen  in  some 
cases  of  epilepsy  during  the  daytime. 


CHAPTEE  III. 

THE   CAUSATION   AND   PREVENTION   OF   INSANITY. 

A.  Etiological. 

The  causes  of  mental  derangement,  as  they  are  -usually  de- 
scribed in  books,  are  so  vague  and  general,  so  little  serviceable 
for  use,  that  the  knowledge  of  them  yields  us  very  little  help 
when  we  are  brought  face  to  face  with  a  concrete  case  and 
endeavour  to  gain  a  clear  conception  of  its  causation.  The 
impossibility  of  getting  precise  information  arises  in  most  in- 
stances from  the  insuperable  difficulties  under  which  we  are  of 
knowdng  a  person's  character  and  history  fully,  intimately,  and 
exactly.  "We  cannot  go  through  the  complex  and  often  tangled 
web  of  his  whole  life,  following  the  manifold  changes  and 
chances  of  it,  and,  seizing  the  single  threads  out  of  which  its 
texture  has  been  woven,  unravel  the  pattern  of  it.  Xo  man 
knoweth  his  own  character,  which  is  ever  under  his  inspection  : 
how  then  can  he  know  that  of  his  neighbour,  w^hen  he  has  only 
brief  and  passing  glimpses  into  it  ? 

Great  mistakes  are  oftentimes  made  in  fixing  upon  the 
supposed  causes  of  the  disease  in  particular  cases  ;  some  single 
prominent  event,  which  was  perhaps  one  in  a  train  of  events, 
being  selected  as  fitted  by  itself  to  explain  the  catastrophe. 
The  truth  is  that  in  the  great  majority  of  cases  there  has  been 
a  concurrence  of  steadily  operatiug  conditions  within  and 
without,  not  a  single  effective  cause.  All  the  conditions, 
whether  they  are  called  passive  or  active,  which  conspire  to  the 
production  of  an  effect  are  alike  causes,  alike  agents ;  all  the 
conditions,  therefore,  which  co-operate  in  a  given  case  in  the 


84  PATHOLOGY  OF  MIND.  [chap. 

production  of  disease,  whether  they  lie  in  the  individual  or  in 
his  surroundings,  must  be  regarded  as  alike  causes.     When  we 
are  told  that  a  man  has  become  mentally  deranged  from  sorrow, 
need,  sickness,  or  any  other  adversity,  we  have  not  learned  much 
if  we  are  content  to  stay  there  :  how  is  it  that  another  man 
who  undergoes  an  exactly  similar  adversity  does  not  go  mad  ? 
The  entire  causes   could  not   have  been  the   same  where   the 
effects  were  so  different.     What  we  want  to  have  laid  bare  is 
the  conspiracy  of  conditions,  in  the  individual  and  outside  him, 
by  which  a  mental  pressure,  inoperative  in  the  one  case,  has 
weighed  so  disastrously  in  the  other ;  and  that  is  information 
which  a  complete  and  exact  biography  of  him,  such  as  never  yet 
has  been  written  of  any  person,  not  neglecting  the  consideration 
of  his  hereditary  antecedents,  could  alone  give  us.     Were  all 
the  circumstances,  internal  and  external,  scanned  closely  and 
weighed  accurately  it  would  be  seen  that  there  is  no  accident  in 
madness ;  the  disease,  whatever  form  it  had,  and  however  many 
the  concurrent  conditions  or  successive  links  of  its  causation, 
would   be  traced  as   the   inevitable  consequence  of   its  ante- 
cedents, just  as  the  explosion  of  a  train  of  gunpowder  may  be 
traced  to  its  causes,  whether  the  train  of  events  of  which  it  is 
the  issue  be  long  or   short.     The  germs  of  insanity  are  most 
often  latent  in  the  foundations  of  the  character,  and  the  final 
outbreak    is    the   explosion   of    a    long   train    of    antecedent 
preparations. 

As  the  causation  of  insanity  may  thus  reach  back  through 
a  lifetime,  and  even  have  its  root  far  back  in  foregoing  genera- 
tions, it  is  easy  to  perceive  how  little  is  taught  by  specifying  a 
single  moral  cause,  such  as  grief,  vanity,  ambition,  which  may 
after  all  be,  and  often  is,  a  prominent  early  symptom  of  the 
disease  which,  striking  the  attention  of  observers,  gets  credit  for 
having  caused  it.  I  am  apt  to  think  that  we  may  learn  more  of 
its  real  causation  by  the  study  of  a  tragedy  like  Lear  than  from 
all  that  has  yet  been  written  thereupon  in  the  guise  of  science. 
A  great  artist  like  Shakespeare,  penetrating  with  subtle  insight 
the  character  of  the  individual  and  discerning  the  relations 
between  him  and  his  circumstances,  apprehending  the  order 
which  there  is  amidst  so  much  seeming  disorder,  and  disclosing 


iii.J      THE  CAUSATION  AND  TREVENTION  OF  INSANITY.        85 

the  necessary  mode  of  evolution  of  the  events  of  life,  embodies 
in  the  work  of  his  creative  art  more  real  information  than  can 
be  obtained  from  the  vague  and  general  statements  which 
science  in  its  defective  state  is  compelled  to  put  up  with. 

Life  in  all  its  forms,  physical  and  mental,  morbid  and  healthy, 
is  a  relation  ;  its  phenomena  result  from  the  reciprocal  action  of 
an  individual  orQ-anism  and  of  external  forces  :  health  is  the 
consequence  and  the  evidence  of  a  successful  adaptation  to  the 
conditions  of  existence,  and  imports  the  preservation,  the  well- 
being,  and  the  development  of  the  organism,  while  disease  marks 
a  failure  in  organic  adaptation  to  external  conditions  and  leads 
to  disorder,  decay,  and  death.  It  is  obvious  that  the  harmonious 
relation  between  the  organism  and  its  environment  which  is  the 
condition  of  health  may  be  disturbed  either  by  a  cause  in  the 
organism  or  by  a  cause  in  the  environment,  or  by  a  cause,  or 
rather  a  concurrence  of  causes,  arising  partly  from  the  one  and 
partly  from  the  other.  When  it  is  said  then  that  a  person's 
mind  has  broken  down  in  consequence  of  adverse  conditions  of 
life,  social  or  physical,  there  is  presupposed  tacitly  some  infirmity 
of  nerve  element,  inherited  or  acquired,  which  has  co-operated ; 
were  the  nervous  system  in  a  state  of  perfect  soundness,  and 
in  possession  of  that  reserve  power  which  it  then  has  to  adapt 
itself  within  certain  limits  to  varying  external  conditions,  it  is 
not  likely  that  unfavourable  circumstances  would  be  sufficient 
so  far  to  disturb  the  relation  as  to  initiate  mental  disease.  But 
when  unfavourable  action  from  without  conspires  with  an  in- 
firmity of  nature  within,  then  the  conditions  of  disorder  are 
established,  and  the  discord,  which  a  madman  is,  is  produced. 

It  has  been  the  custom  to  treat  of  the  causes  of  insanity  as 
physical  and  moral,  but  it  is  not  practicable  to  make  the  dis- 
crimination in  many  cases.  Where  the  existence  of  a  hereditary 
taint,  for  example,  is  the  physical  cause  of  some  moral  defect  or 
peculiarity  of  character  which  issues  at  last  in  insanity,  one 
writer,  looking  to  the  mental  aspect,  will  describe  the  cause  as 
moral,  while  another,  looking  to  the  bad  inheritance,  describes 
it  as  physical.  Certainly,  where  there  is  visible  defective 
development  of  brain  in  consequence  of  a  bad  inheritance,  as  in 
idiocy  sometimes,  all  persons  are  agreed  as  to  the  physical  nature 


86  PATHOLOGY  OF  MIND.  [chap. 

of  the  defect;  but  when  the  cerebral  defect  is  not  gross  and 
patent,  making  itself  known  only  by  some  vice  of  disposition, 
most   people  will   consider  it  to  be  of  a  moral   nature.     The 
truth  is,  on  the  one  hand,  that  in  the  great  majority  of  cases  in 
which  a  so-called  moral  cause  operates  there  is  something   in 
the  physical  constitution  which  co-operates  essentially,  and,  on 
the  other  hand,  that  every  moral  cause  operates  in  the  last 
resort  through  the  physical  changes  which  it  produces  in  the 
nerve-centres.     These  may  be   sudden  and  of  the  nature  of  a 
commotion,  as  when  a  mental  shock  causes  instant  convulsion, 
or  'paralysis,  or  madness ;  or  they  may  be  gradual  and  of  the 
nature  of  organic  growth,  as  when  a  fault  of  character  grows 
with  a  person's  growth,  until  the  balance  of  his  mind  is  over- 
thrown.    It  was  set  forth  at  almost  superfluous  length  in  the 
first  volume  that  thoughts,  feelings,  and  actions  leave  behind 
them   residua  which   are  organized  in   the   nerve-centres,  and 
thenceforth  so  modify  their  manner  of  development  as  to  con- 
stitute an  acquired  nature,  wherefore  what  we  habitually  feel, 
think,  and  do  foreordains  in  great  part  what  we  shall  feel,  think, 
and  do ;  and  as  moral  manifestations  throughout  life  thus  deter- 
mine corresponding  physical  organization,  it  is  evident  that  a 
steadily  acting  moral  cause  of  insanity  is  all  the  while  producing 
its  physical  changes  in  the  occult  recesses  of  the  supreme  nerve- 
centres    of    mind.       In   fact    the   brain   that   is   exercised   so 
regularly  in   a  given  manner   as   to   acquire  during   health   a 
strong  peculiarity  or  bias  of  action  is  sometimes  more  liable  to 
disorder  in  effect  of  this  bias ;  and  when  the  disorder  is  produced 
by  an  independent  cause,  the  bias  or  habit  will,  according  to  its 
good  or  evil   character,  help  to  overcome  or  to  aggravate   its 
effect.      When,  for  example,  insanity  is  the  consummate  ex- 
aggeration of  a  particular  vice  of  character,  the  morbid  symp- 
toms mark  a  definite  habit  of  morbid  nutrition  in  the  su^^reme 
nerve-centres — a  gradually  effected  modification  of  the  mental 
organization  along  a  morbid  line.     On  the  other  hand,  the  brain 
that  is  exercised  habitually  in  the  best  way  acquires  a  strong 
and  healthy   habit   of   thought,   feeling,   and   volition,   which 
counteracts   the   effects   of   a   morbid   strain.      On  the  whole, 
perhaps,  a  man  had  more  need  to  practise  good  habits  than  to 


III.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.        87 

meditate  sound  principles,  if  it  were  a  question  between  the 
two  ;  but  it  is  not,  forasmuch  as  meditation  on  sound  principles 
is  a  preparation  for  the  formation  of  good  habits  that  have  not 
been  tauoht. 

o 

AVith  these  preliminary  remarks  I  go  on  to  consider  those 
general  conditions  which  are  thought  to  predispose  in  some 
way  or  other  to  insanity.  In  the  outset  I  may  make  two  general 
assertions:  that  a  man  is  what  he  is  at  any  period  of  life, 
first,  by  virtue  of  the  original  qualities  which  he  has  received 
from  his  ancestors,  and^  secondly,  by  virtue  of  the  modifications 
which  have  been  effected  in  his  original  nature  by  the  influence 
of  education  and  of  the  conditions  of  life.  But  what  a  complex 
composition  of  causes  and  conditions  do  these  simple  statements 
import !  Hereditary  predisposition  is  a  general  term  which 
connotes,  but  certainly  does  not  yet  denote,  various  intimate  con- 
ditions of  which  we  know  nothing  definite  ;  we  are  constrained, 
therefore,  to  deal  in  general  disquisitions  concerning  it  instead 
of  describing  exactly  its  varieties  and  setting  forth  precisely  the 
laws  of  its  action. 

Heredity. — Whether  it  be  true  or  not,  as  is  sometimes  said, 
that  no  two  leaves  nor  two  blades  of  grass  are  exactly  alike, 
there  can  be  little  doubt  that  no  two  persons  in  the  world  are 
now  or  ever  have  been  exactly  alike.  However  close  the  re- 
semblance between  them,  each  one  has  some  characteristic 
marking  his  individuality  which  distinguishes  him  from  every- 
body else,  and  which  affects  the  course  of  his  destiny.  By  the 
circumstances  of  life  the  development  of  this  intrinsic  quality 
may  be  checked  in  one  direction  or  fostered  in  another  direction, 
but  it  can  never  be  got  rid  of ;  it  is  always  there,  a  leaven 
leavening  the  whole  lump.  In  olden  times  it  was  attributed  to 
the  influence  of  the  particular  star  which  was  in  ascendant  at 
the  time  of  the  mortal's  birth ;  but  the  blow  to  that  easy  theory 
of  causation  was  that  twins  born  under  the  same  planetary 
influence  sometimes  evinced  very  different  dispositions  :  the  two 
twin-sisters  of  Hungary,  who  were  united  by  the  bottom  of 
their  backs  and  had  the  same  blood,  were  of  extremely  different 
temperaments,  and  the  last  years  of  the  Siamese  twins  were 
made  miserable  by  the  quarrels  arising  from  the  different  tastes 
5 


88  PATHOLOGY  OF  MIND.  [chap. 

of  the  brothers,  and  the  different  views  which  they  took  of  the 
American  Civil  War. 

Whence  comes  this  individuality  of  nature  ?  Without  doubt 
it  comes  from  the  same  source  as  the  individuality  of  bodily 
conformation,  of  gait,  of  features — that  is  to  say,  from  ancestors. 
There  is  a  destiny  made  for  each  one  by  his  inheritance ;  he  is 
the  necessary  organic  consequent  of  certain  organic  antecedents ; 
and  it  is  impossible  he  shoXild  escape  the  tyranny  of  his  organi- 
zation. All  nations  in  all  ages  have  virtually  confessed  this 
truth,  which  has  affected  in  an  important  manner  systems  of 
religion,  and  social  and  political  institutions.  The  institution  of 
caste  among  the  Hindoos  owed  its  origin  to  it;  and  there  can  be 
little  doubt  that  the  philosophy  of  that  large  sect  among  them 
which  taught  the  perpetual  re-birth  of  mortals  and  the  develop- 
ment in  this  life  of  the  deeds  done  in  a  former  state  of  being, 
holding  the  antecedent  life  of  a  being  to  be  his  destiny,  was 
founded  on  a  recognition  of  hereditary  action — of  the  fact  that 
the  present  nature  has  descended  from  the  past  by  regular  laws 
of  development  or  of  degeneration.  The  dread,  inexorable 
destiny  which  plays  so  grand  and  terrible  a  part  in  Grecian 
tragedy,  and  which  Grecian  heroes  are  represented  as  struggling 
manfully  against,  knowing  all  the  while  that  their  struggles 
were  foredoomed  to  be  futile,  embodied  an  instinctive  perception 
of  the  law  by  which  the  sins  of  the  father  are  visited  upon  the 
children  unto  the  third  and  fourth  generations.  Deep  in  his 
inmost  heart  everybody  has  an  instinctive  feeling  that  he  has 
been  predestined  from  all  eternity  to  be  what  he  is,  and  could 
not,  antecedent  conditions  having  been  what  they  were,  have 
been  different.  It  was  a  proverb  in  Israel  that  when  the 
fathers  had  eaten  sour  grapes  the  children's  teeth  were  set  on 
edge ;  and  Solomon  justly  proclaimed  it  to  be  one  of  the  virtues 
of  a  good  man  that  he  left  an  inheritance  to  his  children's 
children.  In  village  communities,  where  the  people  remain 
stationary,  and  where  the  characters  of  fathers  and  grandfathers 
are  remembered  or  are  handed  down  by  tradition,  peculiarities  of 
character  in  an  individual  are  often  attributed  to  some  here- 
ditary bias,  and  so  accounted  for :  he  got  it  from  his  fore-elders, 
it  is  said,  and  the  aberration  has  allowance  made  for  it. 


III.]      THE  CAUSATION  AND  PREVENTION  OF  INSANITY.        89 

In  modern  days  we  hardly  take  due  account  of  this  great  truth 
which  ancient  sages  recognised,  and  which  the  experience  of  all 
ages  has  confirmed,  but  it  is  vastly  important  to  us,  if  we  would 
do  well  for  our  race,  to  acknowledge  and  confess  it:  we  are  deter- 
mining in  our  generation  much  of  what  shall  be  predetermined  in 
the  constitution  of  the  generation  that  will  come  after  us,  and  it 
depends  greatly  upon  us  whether  it  shall  be  well  or  ill  with  it. 
Certainly  no  one  has  power  to  change  materially  the  funda- 
mental tendencies  of  his  own  nature ;  the  decrees  of  destiny 
have  gone  forth,  and  he  cannot  withstand  nor  reverse  them ; 
but  if  he  contends  manfully  against  bad  impulses,  as  the  hero 
of  Greek  tragedy  who,  in  the  grasp  of  fatality  and  foredoomed 
to  failure,  abated  no  effort  to  win  an  impossible  victory,  he  will 
by  degrees  modify  his  character  in  part,  and  at  any  rate  he  will 
do  that  which,  being  embodied  as  an  aptitude  in  the  constitu- 
tion of  his  posterity,  may  happily  be  a  stay  and  present  help  to 
them  in  time  of  trouble  and  temptation.  His  efforts  to  over- 
come what  he  cannot  overcome  successfully  may  haply  endow 
their  natures  with  strength  to  be  victorious  in  a  similar  struggle, 
his  pains  being  their  gain,  his  sowing  their  harvest. 

The  least  observation  of  a  young  child's  mind,  as  its  faculties 
are  unfolded  by  education,  shows  how  much  it  owes  to  here- 
ditary action.  How  easily  does  a  well-born  European  child 
learn  in  a  short  time  w^hat,  were  it  not  that  it  has  in  its  consti- 
tution the  benefit  of  ages  of  human  culture — the  quintessential 
abstract  thereof,  so  to  speak — it  would  not  learn  in  years,  if  it 
ever  learned  at  all !  Just  as  it  inherits  muscles  suited  to 
perform  particular  movements,  and  ready,  after  a  little  train- 
ing, to  perform  them  with  ease,  so  it  inherits  in  its  brain 
nervous  substrata  that  embody  the  acquisitions  of  the  culture 
of  its  kind,  and  are  ready,  after  a  little  training,  to  discharge  the 
function  which  has  determined  their  formation  through  the  gra- 
dual experience  of  the  race  from  age  to  age.  ^^"lioever  doubts 
this,  let  him  take  the  child  of  an  Australian  savage  and  the  child 
of  an  ordinary  European  parent,  and  let  him  bestow  the  same 
j)ains  to  give  them  the  same  education ;  in  the  one  case  he  will 
find  that  he  is  playing  upon  a  complex  instrument,  culture- 
tuned,  and  ready  to  give  forth  harmony  on  the  occasion  of  a 


90  PATHOLOGY  OF  MIND.  [crap. 

suitable  touch,  and  in  the  other  case  that  he  has  to  do  with  a 
very  imperfect  instrument,  harsh  and  untuned,  out  of  which  he 
can  only  get  a  few  notes,  and  never  the  highest  notes,  with  all 
the  skill  that  he  can  employ. 

I  might  say,  perhaps,  that  every  human  being  has  four 
natures — his  animal  nature,  his  human  nature,  his  family 
nature,  and  his  individual  nature.  Beneath  the  individual 
characteristics  lies  the  family  nature,  so  that  it  will  happen 
that  in  two  brothers  whose  every  feature  differs  we  perceive 
intuitively  the  family  identity — a  fundamental  identity  in 
diversity,  and,  on  the  other  hand,  in  two  strangers  who  are  very 
like  in  features  we  perceive  intuitively  a  fundamental  differ- 
ence, albeit  we  cannot  describe  it  in  words.  Beneath  the  family 
nature  is  the  more  general  human  nature,  and  beneath  that 
again  the  still  deeper  lying  and  more  general  animal  nature, 
which,  long  way  as  man  is  from  his  nearest  of  animal  kin,  has 
by  no  means  been  worked  out  of  him.  Here  we  have  to  do 
only,  but  enough  to  do,  with  the  inheritance  of   the  family. 

Many  familiar  examples  go  to  prove  that  a  person  inherits 
not  only  the  general  characters  of  the  family,  but  pecu- 
liarities of  manner  and  of  disposition :  tricks  of  thought,  like 
tricks  of  manner,  moods  of  feeling  like  humours  of  body,  are 
inborn  and  come  out  usually  at  one  period  or  another  of  his 
life.  Not  only  are  the  ways  and  looks  of  immediate  ancestors 
thus  reproduced  sometimes,  but  those  of  ancestors  who  are 
remote  and  not  perhaps  in  the  direct  line  of  descent ;  it 
would  seem  in  fact  that  every  parent  has  latent  in  him  the 
abstract  potentialities  of  his  ancestors,  for  I  know  not  how 
many  generations  back  along  the  line  of  descent,  and  that 
these  may  undergo  development  again  in  his  posterity  if  they 
chance  to  meet  with  suitable  stimuli.  To  understand  what 
these  latent  potentialities  are,  he  would  do  well  to  study  their 
developments  in  father,  brothers,  sisters,  uncles,  children — in 
all  branches  of  the  family  tree :  explicit  in  them  he  shall 
read  what  is  implicit  in  himself  And  here  I  may  fitly  take 
notice  that  inherited  qualities  shall  appear  only  at  certain  epochs 
of  life,  the  ancestral  nervous  substrata  being  then  stirred  to 
function  for  the  first  time.    At  puberty,  for  example,  a  bodily  and 


III.]      THE  CAUSATION  AND  PREVENTION  OF  INSANITY.        91 

mental  revolution  takt-s  place,  new  mental  substrata  are  aroused 
to  function,  and  ancestral  characters  sliow  themselves  which  were 
not  noticed  before,  and  probably  never  would  have  been  noticed 
had  the  person  been  made  a  eunuch ;  during  pregnancy  there 
may  be  distinct  manifestations  of  her  mother's  character  in  a 
daughter  which  no  one  had  observed  before ;  and  at  the  change 
of  life,  when  a  woman's  special  functions  are  over,  and  she  tends 
towards  a  masculine  character  of  body  and  mind,  there  may  be 
evinced  pecuharities  which  call  to  mind  a  male  ancestor.  It  is  easy 
to  understand  that  particular  experiences  in  life  may,  like  these 
clianges  in  the  bodily  evolution,  be  fitted  to  awaken  to  function 
latent  or  quiescent  ancestral  nervous  substrata,  and  that  in  this 
way  the  accident  of  an  accident  in  life  may  chance  to  bring  out 
an  ancestral  character  which  otherwise,  like  a  seed  not  brought  to 
bear,  would  have  remained  dormant.  As  it  is  with  the  origin 
and  the  decay  of  instincts  among  animals,  so  it  is  with  the 
development  and  the  decadence  of  these  ancestral  nervous  sub- 
strata: conditions  of  life  suited  to  their  activity  will  stimu- 
late them  to  action  and  will  foster  also  the  development  of  new 
adaptive  tendencies  with  their  appropriate  substrata ;  conditions 
of  life  unsuited  to  their  activity  will  cause  by  degrees  the 
waning  and  the  ultimate  disappearance  of  old  tendencies  with 
their  substrata.  In  this  way  a  slow  evolution  takes  place  through 
the  ages,  and  the  thoughts  of  men  are  gradually  transformed. 
One  consideration  more  with  respect  to  an  individual's  legacy 
from  his  parents  :  he  inherits  not  only  their  general  family  nature 
and  their  original  individual  nature,  but  something  from  their 
individual  characters,  as  these  have  been  modified  by  their 
sufferings  and  doings,  their  errors  and  achievements,  their 
development  or  their  degradation.  Thus  the  work  of  one 
generation  with  its  consequences,  good  or  ill,  is  continued  in  the 
constitution  of  the  next  generation,  living  on  in  it,  and  the  life 
of  a  person  is  the  unbroken  continuation  of  the  life  of  his 
forefathers.  Xo  wonder  that  men  have  invented  doctrines  of 
predestination  and  metempsychosis. 

Very  little  observation,  however,  is  needed  to  show  that  the 
reproductions  of  the  qualities  of  ancestors  is  but  one  side  of 
the  action  of  heredity — that  it  does  not  copy  merely,  but  also 


92  PATHOLOGY  OF  MIND.  [chap. 

invents ;  so  that  an  individual  often  exhibits  marked  differences 
from   any   known  ancestor.      Its  operation  includes  a  law  of 
variation  as  well  as  the  reproduction  of  the  like.     It  is  true  it 
might  be  said  that  the  variations  which  an  individual  presents 
are  not  what  they  seem,  but  repetitions   of  qualities  of  remote 
ancestors  who  have  been  forgotten,  but  it  is  an  assertion  which 
is  opposed  to  what  we  know  of  the  correlations  between  variety 
of  character  and  increasing  complexity  of  social  conditions,  and 
to  the  evident  fact  that  men  in  the  long  run  advance  by  evolu- 
tional  variations  upon  what  they   have   inherited   from  their 
forefathers,  or  go  back  upon  it  by  retrograde  morbid  varieties. 
The  existence  of  different  moral  dispositions  and  intellectual 
capacities  in  twins   and  in  double  monsters  is  sufficient  proof 
that    hereditary    action    is    not    of    the    nature    of    a    mere 
mechanical   copy ;    it   is  rather  of   the   nature   of   a   complex 
chemical  combination,  whereby  compounds  not  resembling  in 
properties   their   constituents   are    oftentimes   produced.      Un- 
happily we  are  yet  as  ignorant  of  the  laws  by  which  combina- 
tions of  germinal  elements  take  place  and  of  the  manifold  varia- 
tions  of   products    which   ensue    therefrom,  as   people   of  old 
were  of  the  combinations  of  chemical  elements  and  of  the  com- 
plex chemical  products  which  result  from  them.     JSTature  builds 
up  a  multitude  of  diff'erent  complex  chemical  products  out  of 
a   few  simple  elements ;   it  can  be  no  cause  of   surprise  then 
that  out  of   the   combinations  of  the  highly  complex  organic 
bodies  which  the  sperm  and  the  germ  elements  are  she  builds 
up  all  the  varieties  of  individual  character.     Consider  the  com- 
plexity of  these  germinal  elements  !     There  is  not  an  organ  of 
the  parent's  body,  we  have  reason  to  think,  not  a  tissue  of  which 
an  organ  is  formed,  not  an  element  probably  of  a  tissue,  which 
has  not  its  idiosyncrasy  represented  in  the  minute  germ  in  some 
latent  and  mysterious  way,  and  which  may  not  therefore  come 
out  in  its  full  traits  of  character  in  the  developed  offspring ;  or, 
if  it  does  not  come  out  in  its  own  character,  serve  to  neutralise, 
supplement,  or   modify   some  quality  in  the  combining  germ 
from   the   other  parent.     Moreover,  if  it  is  neither  developed 
after  its  own  kind  nor  utilised  in  combination,  it  may  lie  com- 
pletely dormant   in  that  generation  and  come  out  in  the  off- 


III.]      THE  CAUSATION  AND  PREVENTION  OF  INSANITY.        93 

spring's  offspring,  or  even  in  a  later  generation ;  for  we  know  not 
in  the  least  how  long  it  may  remain  latent  before  it  is  extinct. 

This  skipping  of  one  generation  and  reappearance  in  a  suc- 
ceeding one  has  been  called  Atavism,  and  has  excited  surprise 
when  it  has  been  observed  in  morbid  heredity :  it  is  so  striking 
sometimes  in  insanity  that  Lndoviciis  Mercatus,  a  Spanish  phy- 
sician, who  wrote  a  book  on  hereditary  diseases,  was  of  opinion 
that  the  insanity  appeared  in  every  other,  or  every  third,  indi- 
vidual in  lineal  descent.  But  it  is  not  so  extraordinary  as  it 
seems ;  for  we  have  a  familiar  physiological  instance  of  the 
same  thing  when  a  daughter  of  a  house  transmits  to  her  son 
any  of  the  special  masculine  qualities  of  her  family,  which  of 
necessity  cannot  be  developed  in  her  body,  or  when  a  son  of  the 
house  transmits  to  his  daughter  any  of  the  special  feminine 
qualities  of  his  family.  In  these  cases  the  special  sexual 
qualities  must  have  been  latent  in  the  intermediate  generation. 
Other  qualities,  healthy  and  morbid,  that  are  not  bound  to  sex 
may  in  like  manner  be  latent  in  a  generation,  if  they  meet  not 
in  the  circumstances  of  the  individual's  life  with  the  conditions 
fitted  to  stimulate  them  into  active  display.  We  assume  them 
to  be  latent  when  they  do  not  show,  but  of  course  we  cannot 
really  say  that  they  are  then  perfectly  in^ictive  ;  they  may,  for 
anything  we  know,  be  held  in  check  by,  or  hold  in  check,  some 
quality  of  the  combining  germ  from  the  other  parent,  or  have 
entered  into  combination  with  it  to  form  a  new  product  with 
qualities  different  from  either  of  its  constituents.  Organic  com- 
bination being  a  matter  of  such  exceeding  complexity  of 
elements,  of  the  nature  and  laws  of  union  of  which  we  have 
not  at  present  the  least  notion,  but  in  comparison  with  which 
we  may  be  sure  the  most  complex  chemical  combination  known 
is  simple,  we  see  reason  enough  why  children  are  not  mere 
stereotyped  copies  of  their  parents,  but  always  exhibit  in 
their  mental  and  bodily  constitutions  and  features  more  or  less 
distinct  evidence  of  a  law  of  variation. 

Not  only  have  we  to  take  note  of  the  complex  character  of 
organic  combinations,  but  we  ought  further  to  note  that  com- 
bining germs  may  be  well  or  ill-fitted  to  combine,  being  in  the 
one  case  of  such  a  character  as  to  make  a  strong  and  stable 


94  PATHOLOGY  OF  MIND.  [chap. 

compound,  and  in  the  other  case  of  a  character  to  mal^e  a  feeble 
and  unstable  compound.  These  greater  or  less  affinities  of  the 
formative  germs  for  one  another  I  take  to  be  a  necessary  conse- 
quence of  the  observation  that  two  persons  may  be  very  well 
suited  or  may  be  very  ill  suited  to  produce  healthy  offspring ;  for 
we  may  look  on  the  germs  as  the  essential  abstracts  of  the  indi- 
viduals from  whom  they  proceed,  containing  in  the  innermost  all 
that  is  explicitly  displayed  in  features  of  body  and  mind,  and 
exhibiting  the  affinities  and  repulsions  which  the  individuals 
exhibit.  It  was  an  Oriental  idea  that  a  complete  being  had 
in  primeval  times  been  divided  into  two  halves,  which  have 
ever  since  been  seeking  to  join  together  and  to  reconstitute  the 
divided  unity.  The  desire  and  pursuit  of  this  unity  is  love, 
and  it  is  accomplished  in  the  happy  union  of  the  sexes,  and  in 
the  production  of  the  new  being  who  proceeds  therefrom. 
Clearly  the  completest  attraction  ought  to  exist  between  the 
individuals  ;  for  if  there  be  indifference  or  repulsion,  as  happens 
sometimes  where  interest  instead  of  affection  makes  a  marriage 
there  cannot  be  that  full  and  harmonious  co-operation  of  all  the 
conditions  which  is  necessary  to  the  best  propagation  ;  not  that 
elective  affinity  by  which  two  beings  are  drawn  together  and 
combine  in  marriage,  like  two  elements  in  nature,  to  form  a  stable 
compound.  As  good  an  author  as  Burdach  maintained  that  the 
beauty  and  ugliness  of  children  were  not  dependent  so  much 
upon  the  beauty  and  ugliness  of  their  parents  as  upon  the  love 
or  aversion  which  they  had  for  one  another ;  and  to  this  opinion 
Lucas  heartily  subscribes.  One  would  have  hesitated  less  to 
assent  to  it  had  it  referred  mainly  to  beauty  and  ugliness  of 
moral  character ;  for  an  ugly  and  unhallowed  union  of  antipa- 
thies can  hardly  fail  to  have  consequences  in  the  inexorable 
logic  of  natural  law. 

All  men  are  of  the  same  species,  and  yet  the  varieties  are  so 
great  that  the  extremes  do  not  combine  well  together ;  if  a  man 
of  the  highest  civilised  race  has  intercourse  with  a  woman  of 
the  lowest  race,  the  probability  is  that  the  intercourse  is  sterile, 
or  if  there  chance  to  be  offspring  it  is  so  much  the  hybrid 
that  it  is  itself  infertile.  Degenerate  or  morbid  varieties 
of  civilised   races   evince  a   similar  incapacity  of  procreation ; 


111.]      THE  CAUSATION  AND  PREVENTION  OF  INSANITY.        95 

sterile  idiocy  being  the  natural  termination  and  extinction  of 
degenerate  varieties  of  tire  human  kind.  In  vain  might  the 
most  curious  despot  attempt  to  propagate  a  race  of  idiots.  These 
extreme  instances  of  a  positive  unaptness  or  repugnance  of  germ 
elements  to  combine  will  serve  to  bring  home  to  the  mind  the 
conception  of  the  existence  of  laws  of  combination  which  are 
in  constant  operation,  and  which  we  are  yet  ignorant  of,  though 
we  may  expect  them  to  be  known  some  day.  Is  it  not  easy  to 
conceive  that,  without  being  so  incompatible  as  to  actually  refuse 
to  combine,  the  germ  elements  may  be  so  far  un suited  to  one 
another  that  when  they  combine  they  do  so  in  a  half-hearted  way 
and  produce  an  unstable  compound  ?  One  frequently  sees  an 
illustration  of  this  in  the  outbreak  of  insanity  in  the  offspring 
of  parents,  one  or  the  other  of  whom  has  been  insane  at  some 
time,  and  I  believe  it  to  be  the  explanation  of  the  distinct  pre- 
disposition to  insanity  wdiich  appears,  so  far  as  the  parents  are 
concerned,  to  be  generated  de  novo  in  the  offspring ;  they  may 
not  themselves  have  ever  been  insane,  nor  may  they  come  from 
families  that  have  any  marked  taint  of  insanity,  yet  they  may, 
by  reason  of  their  mental  or  bodily  characters,  be  as  unfitted  to 
breed  together  successfully  as  if  they  were  positively  insane. 
If  the  popular  notion  be  true,  which  the  instincts  of  all  nations 
seem  to  confirm,  that  consanguineous  marriages  breed  degenerate 
offspring,  the  case  is  one  of  this  kind  :  germs  subsuming  the 
qualities  of  the  same  ancestors,  with  such  little  admixture  of 
new  elements  as  may  chance  to  come  from  the  non-related 
parents,  lack  the  variety  of  composition  w^hich  is  necessary  to 
the  best  combinations,  and  so  are  unfitted  to  produce  a  stable 
compound.  Any  one  who  will  may  make  the  observation  that 
when  two  persons  of  narrow  and  intense  temperament,  having 
great  self-feeling,  distrustful  of  others,  and  prone  themselves  to 
cunning  ways  and  hypocritical  dealings,  mean  in  spirit  as  in 
habits,  perhaps  deceiving  themselves  all  the  while  by  an  in- 
tense affectation  of  religious  zeal  of  evangelical,  ritualistic,  or 
other  extreme  type,  unite  in  marriage  and  have  children,  they 
lay  the  foundations  of  insanity  in  offspring  more  surely  often 
than  an  actually  insane  parent  does.  In  truth  there  are  certain, 
varieties   of   temperament   which,  not   reaching  the  degree  of 


96  PATHOLOGY  OF  MIND.  [chap. 

insanity,  but  tending  more  to  criminal  type,  are  as  likely  by  tlieir 
union  to  generate  it  as  is  tlie  most  positive  mental  derange- 
ment in  one  or  other  of  the  parents  ;  and  foremost  amongst 
them  I  hesitate  not  to  place  the  union  of  essentially  false  and 
hypocritical  natures. 

It  is  a  common  belief  that  genius  is  seldom  inherited,  and 
it  is  certainly  true  that  many  wise  men  have  had  foolish  sons, 
and  that  many  distinguished  men  have  proceeded  from  common 
and  unknown  families.  One  writer  has  gone  so  far  as  to  declare 
that  giants  in  mind,  like  giants  in  body,  are  unfruitful.  One 
may  conceive  the  reason  why  these  extraordinary  developments 
of  mind  or  body  are  not  inherited  to  be  because  they  are  extra- 
ordinary varieties  ;  being  acquired  rather  than  natural  characters 
of  organization,  so  far  therefore  special  deviations  from  the  type, 
they  are  less  likely  to  be  inherited  than  is  some  family  character 
which  belongs  to  the  stock,  goes  along  with  it  in  all  its  individual 
outcomes,  and  requites  no  special  external  conditions  to  aid  its 
development.  There  is  a  repugnance  in  nature  to  extreme 
deviations  from  the  type,  and  when  such  a  deviation  has  occurred 
the  tendency  is  to  revert  to  the  ordinary  type.  IMonsters  deviate 
so  far  from  the  normal  type  that  they  are  either  not  viable  or 
cannot  propagate  themselves  ;  so  it  is  with  actual  diseases,  which 
are  truly  morbid  varieties ;  they  are  not  propagated  as  actual 
diseases  when  they  do  descend  from  father  to  son,  but  as  ten- 
dencies to  disease,  and  they  are  likely  to  be  extinguished  eventu- 
ally in  that  line  of  descent,  either  by  the  operation  of  the 
constant  disposition  which  the  organism  shows  to  revert  to  a 
sound  type,  or,  if  they  get  the  better  of  the  healthy  forces,  by 
their  increase  until  they  put  a  stop  to  propagation.  Mr.  Galton, 
who  wrote  a  book  to  prove  that  genius  is  hereditary,  counting 
among  his  many  examples  hardly  more  than  two  or  three  cases 
of  true  genius,  has  since  perceived  that  all  extraordinary 
characters  in  families  tend  to  revert  to  mediocrity,  whether  the 
deviation  be  in  the  direction  of  ^liis  or  minus,  and  that  in  a 
generation  or  two  this  reversion  is  to  the  equilibrium  from  which 
the  family  variability  had  deviated.  If  it  be  true  that  genius 
is  apt  to  be  infertile,  as  the  giant  certainly  is,  we  must 
suppose  that  the  deviation  from  the  common  type  has  been  so 


111.]      THE  CAUSATION  AND  PREVENTION  OF  INSANITY.        97 

grcafc  as  to  render  the  germ  incapable  of  combination  with  a 
germ  that  is  cast  in  the  common  mould,  and  that  so  nature  at 
once  prevents  by  strong  measures,  as  she  does  in  the  case  of 
idiocy,  the  necessity  of  a  gradual  return  in  the  course  of  genera- 
tions to  the  average  standard  of  mediocrity.  Were  genius  in- 
heritable the  result  would  soon  be  the  development  of  a  higher 
species  of  man  separating  itself  widely  from  a  lower  species. 

In  the  pathological  action  of  the  law  of  variation  or  invention 
of  which  I  have  spoken  we  have  an  explanation  of  the  de  novo 
production  of  a  predisposition  to  insanity,  which  must  manifestly 
have  taken  place  once,  and  which  takes  place  now  from  time  to 
time.     Were  all  madness  swept  from  the  face  of  the  earth  to- 
morrow, past  all  doubt  men  would  breed  it  afresh  before  to- 
morrow's to-morrow.    Two  subjects  concerning  which  information 
may  be  set  down  as  wanting,  and  which  urgently  need  exact 
investigation  at  the  present  time,   are   {a)  The  different  ante- 
cedent conditions  of  the  generation  of  a  predisposition  to  in- 
sanity ;   and   [b)    The    different   signs,  mental   and   bodily,  by 
which  such  a  predisposition  betrays  itself.      Of   the  latter  I 
shall  treat  in  due  course ;  respecting  the  first,  when  it  comes  to 
be  studied  seriously,  I  may  note  that  besides  the  law  of  variation 
which  is  manifested  in  the  results  of  the  combinations  of  germ- 
elements,  we  shall  have  to  take  account — secondly,  of  the  un- 
questionable influence  of  the  particular  mental  and  bodily  state 
of  one  or  both  parents  before  and  at  the  time  of  propagation ; 
thirdly,  of  the  important  influence  upon  the  child's  constitution 
which  is  exerted  for  good  or  ill  by  the  mental  and  bodily  state 
of  the  mother  during  gestation ;  and,  fourthly,  of  the  influences 
brought  to  bear  upon  the  child  during  the  first  years  of  growth 
and   development   of    its    susceptible    nervous    system.      The 
neutralization  of  a  tendency  to  insanity,  through  which  it  comes 
to  pass  that  it  sometimes  becomes   extinct,  is  due,  first,  to  the 
favourable  influence  of  a  happy  marriage,  that  is  to  say,  one 
which  is  antagonistic,  not  consentient,  to  its  development,  and 
secondly,  to  the  beneficial  effect  of  conditions  of  life  suited  to 
check  its  development.     There  is  yet  a  third  weighty  cause  to 
be  taken  into  account,  namely,  the  natural  tendency  of   the 
organism  to  revert  to  the  sound  type.     Were  it  not  for  these 


98  .  PATHOLOGY  OF  jVIIND.  [chap. 

hygienic  acjencies  all  the  world  must  become  mad  sooner  or 
later.  But  as  a  matter  of  fact,  in  the  unceasing  flow  of  the 
stream  of  life  ill  tendencies  are  being  constantly  formed  and 
unformed,  as  chemical  compounds  are  formed  and  unformed. 

I  go  on  now  to  consider  the  meaning  of  insanity  as  an 
aberrant  phenomenon  in  nature  and  of  the  general  conditions 
which  lie  at  its  foundation,  before  entering  upon  the  discussion 
of  its  particular  causes.  Aberrant  or  abnormal,  as  it  may  be 
thought  and  called,  it  comes  by  law,  and  is  just  as  natural  as  the 
normal  phenomena  of  sanity.  It  is  the  clear  business  of  man 
in  the  world  to  adapt  himself  to  the  surrounding  conditions  of 
his  existence  and  to  profit  by  them.  The  gradual  increase  of 
knowledge  and  skill,  which  we  call  progress  of  science  and  art,  is 
the  gain  which  he  makes  as  he  succeeds  in  more  close  and  exact 
adaptation  to  external  nature  by  means  of  improved  methods 
of  observation  of  it  and  corresponding  action  upon  it.  The 
mechanical  conquests  of  the  age  are  no  more  than  systematic 
improvements  of  what  we  do  in  consequence  of  more  accurate 
and  systematic  observation  of  what  we  have  to  do  with :  we 
observe  in  order  to  foresee,  and  foresee  in  order  to  modify  and 
direct,  so  gaining  victories  through  obedience.  Progress  in 
physical  science  and  in  the  arts  which  are  based  upon  it  is  made 
then  by  getting  into  closer  and  closer  harmony  with  nature  and 
by  informing  our  actions  with  the  insight  so  gained — by  making 
them,  in  fact,  a  developmental  advance  upon  nature.  Progress 
in  poetry  and  in  fine  art  has  the  same  basis  and  should  have 
the  same  aim — to  get  closer  insight  into  the  beauties  and  har- 
monies of  nature  and  to  construct  new  art  combinations  which 
shall  be  a  development  of  them— to  make  nature  better  by 
human  means,  the  means  itself  being  still  nature.  To  bring 
self  by  systematically  improved  adaptation  of  feeling,  insight 
and  doing  into  the  most  intimate  possible  harmony  with  nature, 
so  as  almost  to  lose  the  sense  of  self  in  the  larger  sense  of 
oneness  with  it,  must  be  the  means,  I  take  it,  and  should  be 
the  aim,  of  human  evolution.  Failure  in  this  aim,  when  it  falls 
below  a  certain  level,  is  punished  by  manifest  degeneration  and 
disease ;  for  nature  is  sure  to  take  vengeance  upon  those  who 
ignore  or  transgress  its  laws,  observing  not  its  commandments 


III.]      THE  CAUSATION  AND  PliEVENTION  OF  INSANITY.       D9 

to  do  them.  Certainly  it  would  not  be  well  for  any  one  to 
mortify  self  so  far  as  to  get  a  disdain  of  it,  for  he  might  not  then 
care  to  strive  at  all ;  he  will  find  that  to  do  the  best  for  himself 
and  to  do  the  best  for  nature  are  one,  and  that  the  highest  re- 
sults of  his  wisest  striving  culminate  in  a  more  or  less  complete 
self-surrender — in  a  nearer  and  nearer  approach  to  Nirwana. 

Inasmuch  as  a  large  part  of  the  nature  with  which  man  has 
to  come  into  some  sort  of  harmony  is  not  what  we  call  physical 
nature,  but  human  nature,  it  is  plain  that  a  main  business  of 
his  life  will  be  to  adjust  his  relations  to  his  kind.  That  he 
cannot  help  doing  in  the  rudest  form  of  primitive  society ;  the 
control  of  his  own  passion  from  fear  of  the  recalcitrant  kick 
of  his  neighbour's  passion  is  a  solid  foundation  of  a  primitive 
sort  of  social  feeling ;  but  in  a  higher  development  of  the  social 
organism  his  relations  as  a  social  element  become  much  more 
complex  and  special  Sympathy  with  his  kind  and  well-doing 
for  its  welfare,  direct  or  indirect,  are  the  essential  conditions  of 
the  existence  and  development  of  the  more  complex  social 
organism ;  and  no  mortal  can  transcend  these  conditions  with 
any  success.  Let  him  feel,  as  he  well  may,  that  the  play  of 
human  life  is  a  dreary  farce,  that  he  and  his  fellow- workers  are 
but  a  little  higher  than  the  brutes,  and  like  the  brutes  will 
soon  perish  everlastingly — that  all  in  the  end  is  vanity  and 
vexation  of  spirit,  he  must  still  feel  and  work  with  his  kind  if 
he  would  have  health  of  mind.  Misanthropy  is  commonly 
madness  in  the  making.  Hence  it  is  that  humour,  which  always 
is  imbued  with  sympathy,  is  a  higher  and  more  wholesome 
quality  than  cynicism,  which  is  always  inspired  by  contempt. 
If  an  individual  fails  to  bring  himself  into  sympathetic 
relations,  conscious  or  unconscious,  with  surrounding  human 
nature,  he  becomes  a  sort  of  discord,  and  is  on  the  road,  though 
he  may  not  reach  the  end  of  it,  which  leads  to  madness  or  to 
crime :  he  may  be  likened  unto  a  morbid  element  in  the 
physiological  organism,  which  cannot  join  in  function  with  the 
surrounding  elements,  is  an  alien  among  them,  and  must  either 
be  extruded  from  it  or  be  made  harmless  by  sequestration  in  it : 
he  is  truly  an  alien  from  his  kind,  and  with  equal  truth  he  is 
said  to  be  alienated  from  himself,  because  it  is  the  function  of  a 


100  PATHOLOGY  OF  MIND.  [uhap. 

normal  self  to  be  one  with  its  kind.     Eccentricities  of  character, 
when  they  are  not  counterbalanced  by  a  strong  judgment,  are 
apt  to  ripen  into  insanity  either  in  the  individual  or  in   his 
offspring,  and  the  most  appalling  crimes  of  which  history  keeps 
record,  deeds  of  horror  at  which  the  world  turns  pale,  have  been 
perpetrated  by  those  who,  having  gained  or  inherited  authority 
and  power,  were  so  entirely  emancipated  from  the  social  bonds 
of  human  feeling  as  to  be  sometimes  veritable  madmen.     A 
scientific  view  of  the  conditions  of  human  evolution  simply 
brings  us  back  to  the  old  story  which  prophets  have  seen  and 
proclaimed — to  obey  the  commandments  of  God  as  they  are 
written  in  the  laws  of  nature,  and  to  love  one's  neighbour  as 
oneself,  to  conform  humbly,  that  is,  to  physical  and  social  laws. 
If  it  be  true  that  it  is  the  aim  and  the  condition  of  a  just 
development  to  bring  the  individual  into  sympathetic  relations 
with  the  sufferings  and  the  doings  of  his  kind,  it  is  plain  that 
he  who,  distrustful  of  every  one,  pursues  eagerly  his  own  selfish 
schemes,  having  no  regard  to  his  altruistic  functions  as  a  unit  in 
the  social  organism,  must  be  on  the  road  to  initiate  degeneracy  of 
some  kind.     Intense  egoism  of  this  sort  does  in  fact  divide  into 
two  main  branches,  as  the  degeneracy  increases  through  genera- 
tions— namely,  the  insane  and  the  criminal  types,  each  of  which 
has  its  various  subdivisions.    That  the  children's  teeth  are  set  on 
edge  when  the  fathers  have  eaten  sour  grapes  was  not  the  mere 
dream  of  a  seer's  fancy,  but  the  piercing  insight  into  a  natural 
law  by  which  degeneracy  increases  through  generations.     Crime 
and  madness  are  the   active  outcome  of  antisocial  tendencies. 
It  is  well  known  how  hard  a  thing  it  is  sometimes  to  distinguish 
between  these  two  forms  of  human  degeneracy.    There  are,  on 
the  one  hand,  many  criminals  who  exhibit  such  evident  signs  of 
defect  or  unsoundness  of  mind  that  it  is  impossible  to  say  con- 
fidently whether  they  ought  to  be  sent  to  an  asylum  or  to  a 
prison ;  and,  on  tlie  other  hand,  there  are  insane  persons  who 
evince  such  criminal  and  vicious  tendencies  that  one  cannot  help 
feeling  that  the  discipline  of  a  prison  would  be  the  best  treat- 
ment for  them  :  both  proceed  in  descent  from  the  same  anti- 
social stem,  and  it  is  no  wonder  that  their  varieties  intermingle 
indistinguishably  in  the  borderland  where  they  touch. 


III.]      THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       101 

Those  who  liave  had  much  to  do  with  the  treatment  of 
insane  persons  have  not  failed  to  note  the  marked  mental  pecu- 
liarities of  their  near  relations  in  many  instances,  and  to  lament 
that  they  oftentimes  show  themselves  more  distrustful,  more 
difficult  to  reason  with,  more  impracticable,  than  the  member  of 
the  family  who  is  confessedly  insane.  In  the  first  place,  they 
have  such  an  intimate  radical  sympathy  of  nature  with  those 
tendencies  of  character  which  have  culminated  in  insanity  in  him, 
that  they  cannot  sincerely  see  alienation  which  is  patent  to  all 
the  rest  of  the  world :  they  will  minimise  bit  by  bit,  finding 
reason  or  excuse  for  each  strange  act,  feeling,  or  idea,  until  they 
have  accounted  for  all  the  strangeness  of  it,  and  it  only  remains 
for  the  patient  listener  to  confess  that  the  palpable  madness  was 
after  all  very  natural  in  him,  and  that  their  relative  is  not  mad 
like  other  mad  persons,  or  at  any  rate  that  what  would  be  great 
madness  in  all  the  rest  of  the  world  is  not  madness  in  him. 
In  the  second  place,  a.s  a  consequence  of  their  essential  likeness 
and  sympathy  of  nature,  they  will  question,  dispute,  carp  at 
every  restraint  which  those  under  whose  care  he  is  may  find  it 
necessary  to  place  upon  him ;  notwithstanding  that  they  may 
have  been  obliged  to  send  him  from  home  and  to  put  him  under 
control  because  he  was  an  intolerable  trouble  or  an  actual 
menace  and  a  danger,  they  will  talk  as  if  they  would  exact  a 
mode  of  treatment  which  entirely  ignored  his  insanity,  and  will 
end  probably,  if  he  does  not  get  better,  in  the  firm  belief  that 
his  disease  has  been  caused  and  kept  in  action  by  the  improper 
treatment  to  which  he  has  been  subjected.  The  worst  of  them 
would  risk  the  chance  of  his  attendant  being  killed  by  a  lunatic 
rather  than  suffer  what  they  call  his  sensitive  disposition  to 
be  hurt  by  the  necessary  means  of  control,  and  if  such  a  cata- 
strophe happened  their  genuine  sympathies  would  be  with 
him,  not  with  the  victim  of  his  violence.  Their  intensely 
suspicious  and  distrustful  natures,  their  tortuous  habits  of 
thought,  their  wiles  and  insincerities,  their  entire  absorption  in 
a  narrow  selfishness,  mark  a  disposition  which  is  incapable  of 
cominsj  into  wholesome  relations  with  mankind :  it  is  of  a 
character  to  lead  to  guile  in  social  intercourse,  to  petty  fraud  in 
business,  and,  when  the  conditions  of  life  are  hard  and  tempt 


102  PATHOLOGY  OF  MIND.  [chap. 

to  evil-doing,  even  to  crime,  and  which  in  any  case  is  pretty 
sure  to  breed  insanity  or  crime  in  the  next  generation.  Moral 
feeling  is  based  upon  sympathy;  to  have  it  one  must  have 
imagination  enough  to  realise  the  relations  of  others  and  to 
enter  ideally  into  their  feelings ;  whereas  these  persons  have 
not  the  least  capacity  of  going  in  feeling  beyond  the  range  of 
their  family,  unless  it  be  to  embrace  a  favourite  cat  or  dog,  and 
are  goveined  by  an  intense  and  narrow  family  selfishness. 
They  are  capable  sometimes  of  an  extraordinary  self-sacrifice  for 
one  another  within  that  small  circle,  but  they  are  completely 
shut  up  within  it.  Being  in  such  slight  and  unstable  relations 
with  their  kind,  what  wonder  that  a  son  or  daughter  who  has 
descended  from  such  an  unsound  stock,  and  who  most  likely 
sucked  in  suspicion  and  egoism  with  the  mother's  milk,  should 
get  so  far  astray  as  to  be  loosened  from  wholesome  bonds  of 
social  relation  and  to  become  insane  or  criminal  ! 

Good  moral  feeling  is  to  be  looked  upon  as  an  essential  part 
of  a  sound  and  rightly  developed  character  in  the  present  state 
of  human  evolution  in  civilised  lands ;  its  acquisition  is  the 
condition  of  development  in  the  progress  of  humanization. 
Whosoever  is  destitute  of  it  is  to  that  extent  a  defective  beino-  • 
he  marks  the  beginning  of  race -degeneracy ;  and  if  propitious 
influences  do  not  chance  to  check  or  to  neutralize  the  morbid 
tendency,  his  children  will  exhibit  a  further  degree  of  degeneracy 
and  be  actual  morbid  varieties.  Whether  the  particular  outcome 
of  the  morbid  strain  shall  be  vice,  or  madness,  or  crime,  will 
depend  much  on  the  circumstances  of  life,  but  there  is  no  doubt 
in  my  mind  that  one  way  in  which  insanity  is  generated  de 
■vovo  is  through  the  deterioration  of  nature  which  is  shown  in 
the  absence  of  moral  sense.  It  was  the  last  acquisition  in  the 
progress  of  humanization,  and  its  decay  is  the  first  sign  of  the 
commencement  of  human  degeneracy.  And  as  absence  of  moral 
sense  in  one  generation  may  be  followed  by  insanity  in  the 
next,  so  I  have  observed  that,  conversely,  insanity  in  one 
generation  sometimes  leaves  the  evil  legacy  of  a  defective  moral 
sense  to  the  next.  Any  course  of  life  then  which  persistently 
ignores  the  altruistic  relations  of  an  individual  as  a  social  unit, 
which  is  in  truth  a  systematic  negation  of  the  moral  law  of 


III.]      THE  CAUSATION  AND  PREVEXTIOX  OF  INSANITY.       103 

liuman  progress,  deteriorates  his  higlier  nature,  and  so  initiates 
a  degeneracy  which  may  issue  in  actual  mental  derangement  in 
his  posterity. 

When  we  make,a  scientific  study  of  tlie  fundamental  meaning 
of  those  deviations  from  the  sound  type  which  issue  in  insanity 
and  in  crime,  by  searching  inquiry  into  the  laws  of  their  genesis, 
it  appears  that  these  forms  of  human  degeneracy  do  not  lie  so 
far  asunder  as  they  are  commonly  supposed  to  do.  ]\Ioreover, 
theory  is  here  confirmed  by  observation ;  for  it  has  been 
pointed  out  by  those  who  have  made  criminals  their  study  that 
they  oftentimes  spring  from  families  in  wdiich  insanity,  epilepsy, 
or  some  allied  neurosis  exists,  that  many  of  them  are  weak- 
minded,  epileptic,  or  actually  insane,  and  that  they  are  apt  to 
die  from  diseases  of  the  nervous  system  and  from  tubercular 
diseases.  One  might  venture  to  describe,  and  to  place  side  by 
side  as  having  near  relations  to  one  another,  three  neuroses — the 
e^^ileptic,  the  insane,  and  the  criminal  neurosis — each  of  which 
has  its  corresponding  psychosis  or  natural  mental  character. 
In  like  manner  as  the  form  of  every  living  creature  answers  to 
its  habits,  it  desiring  only  what  it  can  attain  by  means  of  its 
organs,  constructed  as  they  are,  and  its  organs  never  urging  it  to 
that  which  it  has  not  a  desire  for,  so  it  is  with  the  particular 
neurosis  of  that  congeries  of  nerve-centres  which  constitute 
specially  the  organ  of  mind ;  it  inspires  a  desire  for  and  deter- 
mines a  tendency  to  that  form  of  mental  activity,  in  other 
words,  to  that  development  of  the  psychosis,  which  is  the  fullest 
expression  of  its  function.  The  sufferer  from  any  one  of  these 
neuroses  represents  an  initial  form  of  degeneracy,  or  a  com- 
mencing morbid  variety,  of  the  human  kind,  and  life  to  him 
will  be  a  hard  struggle  against  the  radical  bias  of  his  nature, 
unless  he  minds  not  to  struggle  and  leaves  it  to  the  free  course 
of  a  morbid  development.  He  is  sadly  weighted  in  running  the 
race  that  is  set  before  him,  since  he  has  an  enemy  in  his  camp, 
a  traitor  in  his  own  nature,  which  is  ever  ready  to  conspire  with 
external  adversities,  and  often  lends  them  a  secret  help,  without 
which  they  would  be  powerless  to  overcome  him. 

When  the  criminal  inmates  of  a  prison  are  studied,  as  they 
need  to  be  more  scientifically  than  they  have  yet  been,  they  are 


104  PATHOLOGY  OF  MIND.  [chap 

not  found  to  bo  quite  so  niucli  alike  as  a  common  name  would 
imply ;  indeed,  they  may  rightly  be  divided  into  three  principal 
classes — {a)  the  first  class,  consisting  of  those  who,  not  being 
really  criminally  disposed,  have  fallen  in  coni^equence  of  the  ex- 
traordinary pressure  of  exceptionally  adverse  circumstances; 
(&)  the  second  class,  of  those  who,  having  some  degree  of  criminal 
disposition,  might  still  have  been  saved  from  crime  had  they  had 
the  advantages  of  a  fair  education  and  of  propitious  conditions 
of  life,  instead  of  the  disadvantages  of  an  evil  education  and  of 
criminal  surroundings  ;  (c)  the  third  class,  of  born  criminals, 
whose  instincts  urge  them  blindly  into  criminal  activity,  what- 
ever their  circumstances  of  life,  and  whom  neither  Ivindness, 
nor  instruction,  nor  punishment  will  reform,  they  returning 
naturally  to  crime  when  their  sentences  are  expired,  like  the 
dog  to  its  vomit  or  the  sow  to  its  wallowing  in  the  mire.  It 
illustrates  the  strength  of  the  instinctive  repugnance  to  anti- 
social beings  that  while  compassion  is  oftentimes  felt  for  a 
criminal  of  the  first  class,  and  apology  made  for  his  crime,  not 
the  least  pity  is  felt  nor  the  least  allowance  made  for  the 
fearful  tyranny  of  his  bad  organization  under  which  the 
criminal  of  the  third  class  groans  and  succumbs.  Clearly 
society  might  justly  commiserate  the  criminal  at  the  same  time 
that  it  deliberately  punished  him  by  sequestration  for  its  own 
certain  protection  and  for  his  possible  reformation. 

In  this  relation  it  is  interesting  to  note  how  much  a  desire  of 
concealment  and  a  feeling  of  disgrace  still  attach  to  the  occurrence 
of  insanity  in  a  family,  despite  all  that  may  be  said  with  regard 
to  its  nature  as  a  defect  or  a  disease  calling  for  compassion. 
The  feeling  has  at  bottom  a  certain  justification  in  the  truth 
that  insanity  is  a  mark  of  family  degeneracy,  the  initiation  of  a 
morbid  A^ariety  of  the  human  kind,  a  proclamation  of  failure  in 
adaptation  to  the  complex  social  and  physical  conditions  of 
civilised  life.  The  sufferer  is  an  outcast  from  the  social  system, 
being  unable  to  conform  to  the  laws  which  govern  social  organi- 
zation and  function.  There  always  has  been,  and  for  a  long 
time  to  come  there  will  no  doubt  still  be.  a  feelin"  of  distrust 
of  and  repugnance  to  the  anti-social  unit  who  has  fallen  from 
his  high  rational  estate  as  a  being  wlio  can  feel,  think,  and  act 


III.]      THE  CAUSATION  AND  PKEVENTION  OF  INSANITY.       105 

with  his  kind,  and  whose  thoughts  and  deeds  are  incompatible 
with  the  social  well-being ;  he  will  lie  under  a  social  ban,  and 
the  family  to  which  he  belongs  will  feel  the  reflected  stigma. 

The  foregoing  considerations  make  it  plain  that  if  all  sorts 
and  conditions  of  insanity  were  swept  clean  from  the  face  of 
the  earth  at  one  stroke,  so  that  hereditary  predisposition  could 
not  work  as  a  factor  in  its  production,  no  long  time  could 
elapse  before  a  new  start  was  given  to  one  or  other  of  its  forms 
of  degeneracy.  It  is  a  mere  question  of  time  when  a  deviation 
from  the  laws  of  social  well-being  shall  reach  such  a  pitch  that 
the  individual  who  is  the  outcome  is  unfit  to  take  his  place  and 
perforin  his  functions  as  a  social  element,  and  must  be  treated 
as  a  morbid  variety  ;  degeneracy  of  the  moral  being  must  ensue 
in  consequence  of  a  persistent  disregard  of  these  laAvs  as  surely 
as  disease  or  death  of  body  will  ensue  from  a  persistent  disregard 
of  the  laws  of  physical  health  ;  and  he  who  is  going  the  way 
of  degeneracy  from  the  ideal  type  of  wholesome  manhood 
plainly  cannot  help,  but  will  hinder  that  evolution  of  the  social 
organism  which,  as  it  is  the  effect,  we  may  take  to  be  in  the 
purpose,  of  nature's  development.  All  those  who  are  going  this 
downward  way,  along  whatever  special  path,  we  might  class 
together  under  the  head  of  anti-social  elements ;  there  would 
be  many  varieties  of  them,  ranging  from  the  first  beginnings 
of  degeneracy  to  the  extremest  forms  thereof. 

It  would  not  perhaps  be  too  absolute  a  statement  to  make — 
That  one  of  two  things  must  happen  to  an  individual  in  this 
world  if  he  is  to  live  successfully  in  it :  either  he  must  be 
yielding  and  sagacious  enough  to  conform  to  circumstances,  or 
he  must  be  strong  enough,  a  person  of  that  extraordinary 
genius,  to  make  circumstances  conform  to  him.  If  he  cannot 
do  either,  or  cannot  manage  by  good  sense  or  good  fortune  to 
make  a  successful  compromise  between  them,  he  will  either  go 
mad,  or  commit  suicide,  or  become  criminal,  or  drift  a  helpless 
charge  upon  the  charity  of  others. 

Having  thus  set  forth  the  meaning  of  insanity  as  an  aberrant 
phenomenon  in  the  social  organization,  and  so  hinted  at  the 
conduct  of  life  which  is  best  suited  to  prevent  it,  I  go  on  now 
to  treat  more  particularly  of  that  definite  predisposition  to  it 


lOG  PATHOLOGY  OF  MIND.  [chap. 

which  is  produced  by  similar  or  allied  disease  in  one  or  other  of 
the  immediate  ancestors. 

Moi'hid  Heredity. — This  is  a  subject  respecting  which  it  is 
not  possible  to  get  exact  and  trustworthy  information.  So 
strong  is  the  feeling  of  disgrace  attaching  to  the  occurrence  of 
insanity  in  a  family,  and  so  eager  the  desire  to  hide  it,  that 
persons  who  are  not  usually  given  to  saying  what  is  not  true 
will  disclaim  or  deny  ostentatiously  the  existence  of  any  here- 
ditary taint,  when  it  is  known  certainly  to  exist  or  is  betrayed 
plainly  by  the  features,  manner,  and  thoughts  of  those  who 
are  denying  it.  Not  even  its  prevalence  in  royal  families  has 
sufficed  to  make  madness  a  fashionable  disease.  The  main 
value  of  the  many  doubtful  statistics  which  have  been  collected 
by  authors  in  order  to  decide  how  large  a  part  hereditary  taint 
plays  in  the  production  of  insanity  is  to  prove  that  with  the 
increase  of  opportunities  of  obtaining  exact  information  the 
greater  is  the  proportion  of  cases  in  which  its  influence  is 
detected ;  the  more  careful  and  exact  the  researches  the  fuller 
is  the  stream  of  hereditary  tendency  which  they  disclose. 
Esquirol  noted  it  in  150  out  of  264  cases  of  his  private  patients ; 
Burrows  clearly  ascertained  that  it  existed  in  six-sevenths  of  the 
whole  of  his  patients ;  on  the  other  hand,  there  have  beeii  some 
authors  who  have  brought  the  proportion  down  as  low  as  one- 
tenth.  ^  Some  years  ago  I  made  a  tolerably  precise  examination 
of  the  family  histories  of  fifty  insane  persons  taken  without 
any  selection ;  there  Avas  a  strongly  marked  predisposition  in  four- 
teen cases — that  is  in  1  in  3"57,  and  in  ten  more  cases  there 
was  sufficient  evidence  of  family  degeneration  to  warrant  more 
than  a  suspicion  of  inherited  fault  of  organization.  In  about 
half  the  cases  then  was  there  reason  to  suspect  morbid  predis- 
position. I  have  recently  inquired  into  the  histories  of  fifty 
more  cases,  all  ladies,  the  opportunities  being  such  as  could  only 

^  Elaborate  statistical  tables  which  have  been  gathered  from  public 
asylum  reports,  in  order  to  exhibit  the  proportions  of  instances  in  which 
hereditary  predisposition  has  existed,  have  never  been  of  any  value,  except 
so  far  as  they  served  to  occupy  or  amuse  those  who  were  at  the  pains  to 
compile  them  ;  only  where  the  inquirer  is  brought  into  the  most  intimate 
relations  with  the  friends  of  the  patients  can  lie  make  an  approach  to 
accuracy,  and  even  then  it  will  be  an  approach  only. 


III.]      THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       107 

occur  in  private  medical  practice,  and  with  these  results :  that 
in  twenty  cases  there  was  the  distinct  history  of  hereditary  pre- 
disposition ;  in  thirteen  cases  there  was  such  evidence  of  it  in 
the  features  of  the  malady  as  to  beget  the  strongest  suspicion 
of  it ;  in  seventeen  cases  there  was  no  evidence  whatever  of  it. 
In  the  second  fifty  cases  my  opportunities  of  getting  informa- 
tion were  more  favourable  in  consequence  of  more  frequent  per- 
sonal intercourse  with  the  friends,  and  it  sometimes  happened 
that  the  information  sought  for  was  obtained  quite  accidentally 
after  lieredity  had  been  denied.  AVhat  is  the  exact  proportion  of 
cases  in  which  some  degree  or  kind  of  hereditary  predisposition 
exists  must  needs  be  an  unprofitable  discussion  in  view  of  the 
difficulty  and  complexity  of  the  inquiry  ;  suffice  it  to  say  broadly 
that  the  most  careful  researches  agree  to  fix  it  as  certainly  not 
lower  than  one-fourth,  probably  as  high  as  one-half,  possibly 
as  high  even  as  three-fourths. 

Two  weighty  considerations  have  to  be  taken  into  account  in 
relation  to  this  question  :  first,  that  the  native  infirmity  or  taint 
may  be  small  or  great,  showing  itself  in  different  degrees  of 
intensity,  so  as  on  the  one  hand  to  take  effect  only  wdien  con- 
spiring with  more  or  less  powerful  exciting  causes,  or  on  the 
other  hand  to  give  rise  to  insanity  even  amidst  the  most  favour- 
able external  circumstances;  and,  secondly,  that  not  mental 
derangement  only  in  the  parents,  but  other  forms  of  nervous 
disease  in  them,  such  as  epilepsy,  paroxysmal  neuralgia,  strong 
hysteria,  dipsomania,  spasmodic  asthma,  hypochondriasis,  and 
that  outcome  of  a  sensitive  and  feeble  nervous  system,  suicide, 
may  predispose  to  mental  derangement  in  the  offspring,  as, 
conversely,  insanity  in  the  parent  may  predispose  to  other  forms 
of  nervous  disease  in  the  offspring.  We  properly  distinguish 
in  our  nomenclature  the  different  nervous  diseases  \vhich  are 
met  wdth  in  practice  according  to  the  broad  outlines  of  their 
symptoms,  but  it  frequently  happens  that  they  blend,  combine, 
or  replace  one  another  in  a  way  that  confounds  our  distinctions, 
giving  rise  to  hybrid  varieties  intermediate  between  those  which 
are  regarded  as  typical. 

This  mingling  and  transformation  of  neuroses,  which  is  ob- 
served sometin^s  in   the  individual,  is  more  plainly  manifest 


103  PATHOLOGY  OF  MIND.  [chap. 

when  the  history  of  the  course  of  nervous  disease  is  traced 
through  generations  ;  if  instead  of  limiting  attention  to  the 
individual  we  go  on  to  scan  and  track  the  organic  evolution 
and  decay  of  a  family — processes  which  are  sometimes  going 
on  simultaneously  in  different  members  of  it,  one  displaying 
the  outcome  of  its  morbid,  another  of  its  progressive  tendencies 
— it  is  seen  how  close  are  the  fundamental  relations  of  certain 
nervous  diseases  and  how  artificial  the  distinctions  between 
them  sometimes  appear.  Epilepsy  in  the  parent  comes  out 
perhaps  as  some  form  of  insanity  in  the  offspring,  or  insanity 
in  the  parent  as  epilepsy  in  the  child.  Estimating  roughly  the 
probable  breeding  results  of  a  number  of  epileptic  parents, 
one  might  say  that  they  would  be  very  likely  to  lose  many 
children  at  an  early  age ;  that  the  chances  were  great  that 
some  children  would  be  epileptic  ;  and  that  there  was  almost 
as  great  a  risk  that  some  would  become  insane.  Chorea  or 
other  convulsions  in  the  child  may  be  the  consequence  of  great 
nervous  excitability,  natural  or  accidentally  produced,  in  the 
mother.  In  families  where  there  is  a  strong  predisposition  to 
insanity,  one  member  shall  sometimes  suffer  from  one  form  of 
nervous  disease,  and  another  from  another  form  :  one  perhaps  has 
epilepsy,  another  is  afflicted  with  a  severe  neuralgia  or  with 
hysteria,  a  third  may  commit  suicide,  a  fourth  becomes  mania- 
cal or  melancholic,  and  it  might  even  hapj^en  sometimes  that  a 
fifth  evinced  remarkable  artistic  talent.  Neuralgic  headaches 
or  megrims,  various  spasmodic  movements  or  tics,  asthma  and 
allied  spasmodic  troubles  of  breathing  will  oftentimes  be  dis- 
covered to  own  a  neurotic  inheritance  or  to  found  one.  The 
neurotic  diathesis  is  fundamental ;  its  outcomes  are  various,  and 
determined  we  know  not  how ;  but  they  may,  I  think,  be 
either  predominantly  sensory,  or  motor,  or  trophic  in  character. 

Were  we  only  as  exact  as  we  could  wish  to  be  in  our  re- 
searches we  ought  then,  in  studying  hereditary  action  and  its 
issues,  to  mark  the  different  roads.  It  is  plain  there  may  be 
{a)  Heredity  of  the  same  form — that  is,  when  a  person  suffers 
from  the  same  kind  of  mental  derangement  as  a  j)arent  had 
which  he  seldom  does  except  in  the  cases  of  suicide  and  dipso- 
mania; (&)  Heredity  of  allied  form,   as  when  he  suffers   from 


iii.l      THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       109 

another  kind  of  mental  derangement  than  that  which  his  parent 
had — is  maniacal,  for  example,  when  he  or  she  was  melan- 
cholic ;  and  (c)  Heredity  with  transformation  of  neurosis — when 
the  ancestral  malady  was  not  mental  derangement  of  any 
sort,  but  some  other  kind  of  nervous  disease.  Whatever  the 
exact  number  of  cases  of  mental  disorder  in  which  hereditary 
predisposition  of  some  degree  or  kind,  derived  from  the  preced- 
ing or  from  a  more  remote  generation,  is  positively  ascertained, 
it  may  be  asserted  broadly  that  in  the  majority  there  has  been 
a  native  instability  or  infirmity  of  nervous  element  in  the  in- 
dividual whereby  he  has  been  unable  to  bear  the  too  heavy 
burden  of  his  life,  and  lias  broken  down  in  mind.  Complex  and 
various  as  the  constitutional  idiosyncrasies  of  men  notably  are, 
it  is  obvious  that  statistics  can  never  yield  exact  and  conclusive 
information  concerning  the  causation  of  insanity  ;  here,  as  in  so 
many  other  instances  of  their  employment,  their  principal  value 
is  that  they  make  known  distinctly  the  existence  of  a  certain 
tendency,  so  to  speak,  which,  once  we  have  fairly  grasped  it, 
furnishes  a  good  starting-point  for  further  and  more  rigorous 
researches :  they  indicate  the  direction  which  a  more  exact 
method  of  inquiry  should  take. 

It  will  not  be  amiss  to  take  note  here  that  the  filiation  of 
nervous  disease  is  displayed  more  plainly  in  the  so  called 
functional  disorders,  in  which  we  are  not  able  to  detect  any 
morbid  change  of  structure  after  death,  than  in  the  so  called 
organic  diseases,  in  which  there  is  visible  deterioration  of 
structure.  The  reason  probably  is  this :  functional  (diseases 
mark  an  intrinsic  disorder  of  nerve  element  itself,  of  ultramicro- 
scopical  delicacy — intranervine  so  to  speak — while  the  gross 
destruction  of  nerve-structure  which  we  observe  in  organic 
disease  is  usually  a  secondary  effect,  extranervine,  the  primary 
disease  having  originated  in  the  walls  of  the  blood-vessels  or  in 
the  elements  of  the  connective  tissue.  For  example,  when  an  extra- 
vasation of  blood  breaks  down  the  nerve  structure  in  the  neisfh- 
bourhood  of  the  burst  vessel,  it  is  the  degenerate  artery  which  is 
at  fault ;  and  when  a  syphilitic  or  a  cancerous  tumour  grows  in 
the  brain  to  the  detriment  of  the  nervous  structure  on  which  it 
encroaches   steadily,   it  has   had   its   origin   not   in  the  nerve 


no  PATHOLOGY  OF  MIND.  [chap. 

element,  but  in  the  perivascular  spaces  or  in  the  elements  of  the 
connective  tissue.  In  both  cases  we  have  to  do  with  a  disease  of 
nutrition  rather  than  with  an  essential  disease  of  nerve  element. 
The  mental  and  nervous  symptoms  which  occur  are  incidental 
to  the  progress  of  the  disease,  not  of  its  essence,  bemg  due 
either  to  the  direct  destruction,  or  to  the  irritation,  direct 
or  reflex,  of  nerve  structure  by  the  extravasated  blood  or  the 
morbid  growth ;  and  hereditary  action,  if  it  showed  itself  at 
all,  might  be  expected  to  show  itself  in  degenerate  blood- 
vessels or  in  similar  morbid  growths  in  the  brain  or  elsewhere 
in  the  body. 

Nevertheless  it  must  have  chanced  to  every  physician  who 
has  had  much  to  do  with  nervous  diseases  to  have  seen  cases  in 
which  a  parental  apoplexy  has  seemed  to  have  distinctly  pre- 
disposed to  insanity  in  the  offspring.  I  call  to  mind  an  instance 
in  which  four  grown  up  members  of  a  family  of  ten  children 
are  already  insane,  and  more  will  probably  become  so.  I  know 
nothing  more  of  their  hereditary  antecedents  than  that  neither 
father  nor  mother  was  insane ;  both  were  extremely  energetic 
and  industrious,  and  they  built  up  from  the  humblest  beginnings 
by  their  joint  exertions  a  large  and  lucrative  business  in  London. 
The  mother  was  of  an  anxious,  inconstant,  impatient,  and  some- 
what irritable  temperament,  always  actively  employed  and  an 
eager  woman  of  business,  and  she  died  at  a  good  age.  The 
father,  who  was  of  a  sanguine,  choleric,  and  active  temperament, 
died  two  years  after  her  from  apoplexy,  having  had  a  previous 
attack  from  which  he  had  recovered.  Though  warned  very  gravely 
after  the  first  attack  to  be  careful  and  temperate  in  work  and  in 
habits,  he  paid  not  the  least  regard  to  the  admonition,  but  was 
eagerly  employed  in  extending  his  business  to  the  moment 
when  he  was  struck  down  by  the  fatal  attack.  In  this  case 
the  apoplectic  catastrophe  was  plainly  not  the  beginning  of  the 
line  of  pathological  degeneracy ;  account  ought  to  be  taken  of 
the  neurotic  temperament  which  went  before  it,  the  eager,  con- 
tinued, and  somewhat  turbulent  function  of  which,  involving  a 
full  and  brisk  determination  of  blood  to  the  brain,  might  well 
produce  a  too  great  and  unintermitting  strain  upon  the  walls  of 
the  bloodvessels,  and  so  occasion  degeneration  of  their  structure ; 


iir,]      TPTE  CAUSATION  AND  PREVENTION  OF  INSANITY.       Ill 

wherefore  it  was  not  the  actual  bursting  of  the  weakened 
vessel,  but  the  antecedent  conditions  of  nerve  element,  which 
should  be  accounted  the  true  predisposing  cause.  This  has 
been  the  real  order  of  events,  I  believe,  in  other  cases  in  which 
apoplexy  has  appeared  to  predispose  to  insanity :  in  one  genera- 
tion might  be  noted  irritability,  a  tendency  to  cerebral  conges- 
tion, with  passionate  and  violent  outbreaks,  ending  perhaps  in 
an  apoplectic  stroke;  in  the  next  generation  a  tendency  to 
cerebral  haemorrhage,  and  the  appearance  of  such  neuroses  as 
epilepsy,  suicidal  disposition,  and  some  form  or  other  of  mental 
derangement. 

There  is  reason  to  think  that  an  innate  taint  or  infirmity 
of  nerve-element  may  modify  the  manner  in  which  other 
diseases  commonly  manifest  themselves ;  for  example,  where  it 
exists,  gout  flying  about  the  body  will  occasion  obscure  nervous 
symptoms  which  puzzle  the  inexperienced  practitioner,  and  it 
will  sometimes  issue  in  a  downright  attack  of  insanity,  instead 
of  showing  itself  by  its  ordinary  inflammations.  On  the  other 
hand,  there  is  no  doubt  that  a  parental  disease  which  does  not 
affect  specially  tbe  nervous  system  may  notwithstanding  be  at 
the  foundation  of  a  delicate  nervous  constitution  in  the  off- 
spring :  scrofula,  phthisis,  syphilis  perhaps,  gout  and  diabetes 
appear  sometimes  to  play  this  part.  On  going  through  an  idiot 
asylum  the  appearance  of  scrofula  among  its  inmates  is  suffi- 
ciently striking ;  perhaps  two-thirds,  or  even  more,  of  all  idiots 
are  of  the  scrofulous  constitution.^  Lugol,  who  wrote  a  treatise 
on  scrofula,  professes  to  have  found  insanity  by  no  means  un- 
common amongst  the  parents  of  scrofulous  and  tuberculous 
persons,  and  in  one  chapter  he  treats  of  hereditary  scrofula 
from  paralytic,  epileptic,  and  insane  parents.  In  estimating  the 
value  of  observations  of  this  kind,  however,  we  may  easily  be 
deceived  unless  we  are  careful  to  reflect  that,  independently  of 
any  special  relation  between  the  two  diseases,  the  enfeebled 
nutrition  of  scrofula  would  be  likely  to  light  up  any  latent  pre- 
disposition to  insanity  which  there  might  be,  and  so  might  seem 
to  have  originated  it  when  it  w^as  only  a  contributory  factor, 
and,   on   the  other  hand,  that  insanity,   and   especially  those 

^  On  Idiocy  and  Imhecility.     By  William  W.  Ireland.     1877,  p.  24. 
6 


112  PATHOLOGY  OF  MIND.  [chap. 

forms  of  it  in  whicli  nutrition  was  much  affected,  would  foster 
the  development  of  a  predisposition  to  scrofula  or  plithisis. 

Several  writers  on  insanity  have  taken  notice  of  a  connection 
between  it  and  phthisis  which  they  have  thought  to  be  more 
than  accidental.     Schroeder  van  der  Kolk  was  confident  that 
a  hereditary  predisposition  to  phthisis  might  predispose  to  or 
develop  into  insanity,  and,  on  the  other  hand,  that  insanity  pre- 
disposed to  phthisis.    With  phthisis,  however,  there  commonly 
goes,  as  is  well-known,  a  particularly  eager,  intense,  impulsive, 
and  sanguine  temperament,  which  may  breed  a    more  insanely 
disposed  temperament  in  the  offspring,  apart  from  any  influence 
which  the  actual  tubercular  tendency  may  be  supposed  to  have 
or  to  have  not.    I  am  the  more  apt  to  think  this  the  explanation, 
because  there  is  a   third-rate  artistic   or  poetic  temperament, 
altogether  wanting  in  sobriety,  breadth,  and  repose,  and  mani- 
festing itself  in  intense  but  narrow  idealisms,  of  an  extrava- 
gant or  even  grotesque  character  sometimes,  or  in  caterwauling 
shrieks  of  emotional  spasm,  put  forth  as  poetry,  which  closely 
resembles  the  phthisical  temperament,  and  which  is  very  likely 
to   breed   insanity.      There   is  no   question  in   my  mind  that 
insanity  and  phthisis  are   often   met  with  as  concomitant  or 
sequent  effects  in  the  course  of  family  decadence,  whether  they 
predispose  to  one  another  or  not ;  they  are  two  diseases  through 
which  a  family  stock  that  is  undergoing  degeneracy  gradually 
becomes  extinct,  especially  in  those  cases  where  the  degeneracy 
is  the  outcome  of  breeding  in  and  in  until  all  variety  and  vigour 
have  been  bred  out  of  the  stock.    When  we  are  searching  for  the 
predisposing  conditions   of  a  morbid  neurosis  in  a  particular 
case,  and  fail  to  discover  any  history  of  antecedent  insanity  or 
epilepsy,  we  shall  do  well  then  to  inquire  whether  phthisis  is  a 
family  disease.     It  is  alleged  that  as  many  as  tw^o-thirds  of  all 
idiots  die  of  phthisis.     According  to  Dr.  Clouston's  observations, 
made  at  the  Morningside  Asylum,  tubercular  deposit  is  twice  as 
frequent  in  the  bodies  of  those  who  die  insane  as  it  is  in  the 
bodies  of  those  who  die  sane,  and  he  professes  to  have  found  a 
distinctly  greater  frequency  of  hereditary  predisposition  to  in- 
sanity among  the  tubercular  than  among  the  non-tubercular 
patients.    There  is  not,  I  think,  sufficient  reason  to  suppose  that 


Til.]      THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       113 

the  remarkable  remission  of  the  symptoms  of  insanity  whicli  un- 
doubtedly takes  place  often  during  the  exacerbation  of  phthisis 
in  a  patient  who  has  the  two  diseases,  w^ith  the  active  recur- 
rence of  the  mental  symptoms  when  the  signs  of  phthisical 
activity  abate,  testifies  to  any  special  connection  between  them ; 
for  it  appears  to  be  no  more  than  an  instance  of  such  abatement 
of  mental  symptoms  as  is  observed  when  otlier  acute  disease 
befalls  in  an  insane  patient. 

Diabetes  is  a  disease  whicli  often  shows  itself  in  families  in 
which  insanity  prevails  :  whether  the  one  disease  predisposes 
in  any  way  to  the  other  or  not,  or  whether  they  are  independent 
outcomes  of  a  common  neurosis,  they  are  certainly  found  to  run 
side  by  side,  or  alternately  with  one  another,  more  often  than 
can  be  accounted  for  by  accidental  coincidence  or  sequence. 
For  the  present  I  am  content  to  note  the  fact  that  the  children 
of  a  diabetic  parent  sometimes  manifest  neurotic  peculiarities, 
without  devising  an  explanation  which  must  be  hypothetical. 
This  w^e  know :  that  diabetes  is  sometimes  caused  in  man  by 
mental  anxiety ;  that  it  is  produced  artificially  in  animals  by 
irritation  of  the  fourth  ventricle  and  some  adjacent  parts  of  the 
brain ;  and  that  a  great  many  diabetic  patients  die  of  phthisis. 
Perhaps  I  might  set  it  down  as  a  true  generalization  that  the 
morbid  neurosis,  when  it  is  active  and  gets  distinct  morbid 
expression,  may  manifest  itself  in  four  ways — {a)  in  disorder  of 
sensation — for  example,  paroxysmal  neuralgia;  (h)  in  disorder 
of  motion — for  example,  epilepsy;  (c)  in  disorder  of  thought 
feeling,  and  will — mental  derangement ;  (d)  in  disorder  of 
nutrition,  whereof  diabetes  is  the  earlier  and  phthisis  the  later 
stao-e. 

The  late  M.  Morel  of  Eouen  prosecuted  some  original  and  in- 
structive researches  into  the  formation  of  degenerate  or  morbid 
varieties  of  the  human  kind,  showing  the  steps  of  the  descent 
by  which  degeneracy  increases  through  generations,  and  issues 
finally,  if  unchecked  by  counteracting  influences,  in  the  extinc- 
tion of  the  family.  AYhen  some  of  the  unfavourable  conditions 
of  life  which  are  believed  to  originate  disease — such  as  the 
poisoned  air  of  a  marshy  district,  the  unknown  endemic  causes 
of  cretinism,  the  overcrowding  and  starvation  of   large  cities, 


lU  PATHOLOGY  OF  MIND.  [chap. 

continued  intemperance  or  excesses  of  any  kind,  frequent  inter- 
marriaf,^es  in  families — have  engendered  a  morbid  variety,  it  is 
tlie  beginning  of  a  calamity  which  may  gather  force  through 
generations,  until  the  degeneration  has  gone  so  far  that  the  con- 
tinuation of  the  species  along  that  line  is  impossible.  Insanity, 
of  what  form  soever,  whether  mania,  melancholia,  moral  in- 
sanity, dementia,  may  be  looked  upon  then  philosophically  as 
a  stage  in  the  descent  towards  sterile  idiocy ;  as  might  be  proved 
experimentally  by  the  intermarriage  of  insane  persons  for  two 
or  three  generations,  and  as  is  proved  undesignedly  sometimes 
by  the  disastrous  consequences  of  frequent  intermarriages  in 
foolish  families.  The  history  of  one  family  which  Morel  in- 
vestigated with  great  care  may  be  quoted  as  an  extreme 
example  of  the  natural  course  of  degeneration  when  it  goes  on 
unchecked  through  generations.  Were  it  an  invention  only, 
it  would  be  one  of  those  inventions  that  teach  excellent  truth. 
It  may  be  summed  up  thus  : — 

First  Generation. — Immorality,  depravity,  alcoholic  excesses, 
and  gi'eat  moral  degradation  in  great-grandfather,  who  was 
killed  in  a  tavern  brawl. 

Second  Generation. — Hereditary  drunkeimess,  maniacal  attacks 
ending  in  general  paralysis  in  the  grandfather. 

Third  Generation. — Sobriety,  but  hypochondriacal  tendencies, 
delusions  of  persecution,  and  homicidal  tendencies  in  the 
father. 

Fourth  Generation. — Defective  intelligence.  First  attack  of 
mania  at  sixteen  years  of  age ;  stupidity  and  transition  to  com- 
plete idiocy.  Probable  extinction  of  the  morbid  line ;  for  the 
generative  functions  were  as  little  developed  as  those  of  a  child 
of  twelve  years  of  age.  He  had  two  sisters,  who  were  both 
defective  physically  and  morally,  and  were  classed  as  imbeciles, 
To  make  the  proof  of  morbid  heredity  more  striking,  it  may  be 
added  that  the  mother  had  an  adulterous  child  while  the  father 
was  confined  in  the  asylum,  and  that  this  child  did  not  exhibit 
any  signs  of  degeneracy. 

In  this  history  of  a  family  we  have  an  instructive  example 
of  a  retrograde  movement  of  the  human  kind,  ending  in  so  wide 
a  deviation  from  the  normal  type  that  sterility  ensues ;  it  is  the 


III.]      THE  CAUSATION  AND  PliEVENTION  OF  INSANITY.      115 

opposite  of  that  movement  of  progressive  specialization  and 
increasing  complexity  of  relation  with  the  external  which  mark 
advancing  development.  All  the  moral  and  intellectual  acqui- 
sitions of  culture  which  the  race  has  been  slowly  putting  on  by 
organized  inheritance  of  the  accumulated  experience  of  count- 
less generations  of  men  are  rapidly  put  off  in  a  few  generations, 
until  the  lowest  human  and  fundamental  animal  elements  only 
are  left  in  an  abortive  state ;  in  place  of  sound  and  proper 
social  elements  which  may  take  their  part  and  discharge  their 
function  harmoniously  in  the  social  organism  v/e  have  morbid 
elements  fit  only  for  excretion  from  it.  The  comparison  of  the 
social  fabric  with  the  bodily  organism  is  well  founded  and  in- 
structive. As  in  bodily  disease  there  is  a  retrograde  meta- 
morphosis of  formative  action  whereby  morbid  elements  are 
produced  which  cannot  minister  to  healthy  function,  but  will,  if 
not  got  rid  of,  occasion  disorder  or  death ;  so  in  the  social  fabric 
there  is  likewise  a  retrograde  metamorphosis  whereby  morbid 
varieties  or  degenerations  of  the  human  kind  are  produced, 
which,  being  antisocial,  will,  if  not  rendered  innocuous  by 
sequestration  in  it,  or  if  not  extruded  violently  from  it,  give 
rise  to  disorder  incompatible  with  its  stability.  How  exactly 
do  the  results  of  degeneracy  accord  with  what  was  said  concern- 
ing the  aim  of  human  progress  and  the  fundamental  meaning 
of  insanity ! 

Let  it  be  noted  that  however  much  man  may  degenerate 
from  his  high  estate  he  never  actually  reverts  to  the  exact 
type  of  the  animal,  though  he  may  sink  in  idiocy  to  a  lower 
stage  of  degradation  than  it;  when  he  has  been  stripped  of 
all  his  essential  human  qualities  and  degraded  almost  to  his 
bare  animal  instincts,  he  certainly  presents  an  animal  like- 
ness which  may  justify  the  description  of  his  condition  as  a 
theroicl  degeneracy  ;  but  he  is  unlike  in  these  respects — first,  that 
his  mental  wreck  yields  evidence  of  the  height  from  which  he 
has  fallen,  and,  secondly,  that  the  fundamental  instincts  w^ant 
the  vigour  and  wholesome  activity  of  the  animal,  or  are  actually 
debased.  The  latter  can,  by  virtue  of  its  healthy  instincts, 
adjust  itself  successfully  to  its  surroundings  and  flourish;  he, 
unable  to  do  .«o  by  reason  of  the  debasement  of  his  instincts  or 


116  PATHOLOGY  OF  MIND.  [chap. 

of  their  unfitness  to  cope  witli  the  complexity  of  his  surround- 
ings, would  perish  soon  but  for  the  helpful  care  of  his  kind. 

In  the  lowest  forms  of  insanity  and  idiocy  there  are  sometimes 
exhibited  remarkable  animal-like  instincts  and  traits  of  cha- 
racter, wdiich  may  even  go  along  with  corresponding  conforma- 
tion of  body :  witness  the  stories  told — I  know  not  how  truly — 
of  idiot  mothers  who,  after  delivery,  have  gnawed  through  the 
umbilical  cord;  the  idiot  described  by  Pinel,  who  was  much 
like  a  sheep  in  appearance,  in  habits,  and  in  his  cry ;  the  idiot 
described  by  Dr.  Mitchell,  wdio  presented  a  singular  resemblance 
to  a  monkey  in  his  features,  in  the  conformation  of  his  body,  and 
in  his  habits ;  the  habit  of  rumination  of  food  which  has  been 
observed  in  some  insane  persons  and  idiots,  and  the  savage  fury 
and  the  bestialities  exhibited  by  others  : — all  these  testify  to 
the  brute  brain  within  the  man's,  and  may  be  looked  upon  as 
instances  of  partial  reversion,  proofs  that  the  animal  has  not 
yet  completely  died  out  of  him,  faint  echoes  from  a  far  distant 
past  testifying  to  a  kinship  which  he  has  almost  outgrown.  It 
may  be  thought  a  wild  notion  that  man  should  even  now  dis- 
play traces  of  his  primeval  kinship  when  countless  ages  have 
confessedly  elapsed  since  he  started  on  the  track  of  his  special 
development,  but  a  little  consideration  will  take  from  the 
strangeness  of  it.  In  the  first  place,  long  way  as  he  is  from 
the  animals,  he  still  passes  in  the  course  of  his  embryonic  de- 
velopment through  successive  stages  at  which  he  resembles  not 
a  little  the  permanent  conditions  of  certain  classes  of  them ;  he 
may  be  said,  in  fact,  to  represent  in  succession  a  fish,  a  bird,  a 
quadruped  in  his  course  before  he  becomes  human ;  and  these 
transitional  phases  are  presumably  to  be  interpreted  as  the 
abstract  and  brief  chronicle  of  the  successive  throes  or  stages 
of  evolution  through  which  nature  went  before  man  w^as  brought 
forth.  Whether  that  be  so  or  not,  the  metamorphoses  are  proofs 
at  any  rate  that  the  foundations  of  his  being  are  laid  upon 
the  same  lines  as  those  of  the  vertebrate  animals,  and  that  he 
has  deep  within  him  common  qualities  of  nature  which,  when 
the  higher  qualities  of  his  special  nature  are  gone,  will  manifest 
themselves  in  animal-like  traits  of  character.  In  the  second 
place,  let  any  one  consider  curiously  the  fundamental  instincts 


III.]      THE  CAUSATION  AND  PREVENTION  OF  JNSANITY.      117 

of  self-conservation  and  propagation,  resolutely  laying  bare  their 
roots,  taking  note  of  their  intimations  in  children  long  before 
tlieir  meaning  is  understood  by  them,  and  giving  attention  to  their 
manifestations  amonsj  all  sorts  and  conditions  of  men,  savasre  and 
civilised,  he  will  not  fail  to  perceive  and  confess  how  thoroughly 
animal  is  man  at  bottom.  He  will  apprehend  this  the  more  clearly 
if  he  goes  on  to  trace,  as  he  may,  the  development  of  many 
of  the  highest  qualities  of  human  intelligence  and  feeling  from 
their  roots  in  these  fundamental  instincts.  Our  s}Tiipathies  with 
other  livinor  thincrs,  our  interests  in  their  sufferinf^s  and  doings, 
our  success  in  understandinsr  them  and  making  ourselves  under- 
stood  by  them,  our  power  to  train  and  use  them  for  our  services, 
^vould  be  impossible  but  for  a  common  foundation  of  nature. 

It  has  been  a  question  whether  a  father  or  a  mother  was  more 
likely  to  transmit  an  insane  bias  to  the  children.  Esquirol 
found  that  it  descended  more  often  from  the  mother  than  from 
the  father,  and  from  the  mother  to  the  daughters  more  often 
than  to  the  sons  ;  and  to  this  opinion  Baillarger  subscribes. 
From  an  elaborate  report  to  the  French  Government  by  M. 
Behic  it  would  seem  that  it  is  most  likely  to  pass  from 
father  to  son  and  from  mother  to  daughter  ;  for  out  of  1,000 
admissions  of  each  sex  into  French  asylums  he  found  that  264 
males  and  266  females  had  suffered  from  hereditary  predispo- 
sition;  that  of  the  264  males  128  had  inherited  the  disease 
from  their  fathers,  110  from  their  mothers,  and  26  from  both 
parents  ;  and  that  of  the  266  females,  100  had  inherited  from 
fathers,  130  from  mothers,  and  36  from  both  parents.  It  might 
be  questioned  whether  the  sex  of  the  parent  in  itself  has  much 
directly  to  do  with  determining  the  line  of  descent  to  son  or 
daughter ;  it  is  not  perhaps  that  the  male  inherits  preferenti- 
ally from  the  male,  and  the  female  from  the  female,  by  virtue  of 
sex,  but  that  there  is  more  insanity  inherited  from  one  or  the 
other  accordinsj  as  there  are  more  male  or  female  children  amonj' 
the  offspring.  If  male  children  have  preponderated  in  the 
family  of  the  father  who  transmits  the  insanity  to  his  children, 
and  if  he  displays  in  marriage  that  superior  potency  in  propa- 
gation by  which  his  family  tendency  obtains  and  male  children 
preponderate  among  his  offspring,  there  will  most  likely  be  more 


118  PATHOLOGY  OF  MIND.  [ohap. 

cases  of  insanity  descending  fi-om  father  to  son,  but  if  female 
children  preponderate  among  his  offspring,  it  is  probable  that 
there  will  be  a  stronger  stream  of  descent  from  father  to  danghter 
To  get  at  real  information  we  should  have  to  go  deeper  and  to 
discover  the  unknown  causes  which  determine  sex.  It  is  hard 
to  understand  that  a  daughter  who  resembles  an  insane  father  in 
her  whole  temperament  of  body  and  mind  more  than  a  son  does 
should  be  less  likely  than  the  son  to  inherit  a  morbid  taint  of 
character  from  him.  Mr.  Galton's  ^  first  inquiries  concerning 
hereditary  genius  led  him  to  the  conclusion  that,  contrary  to 
common  opinion,  the  female  influence  was  inferior  to  the  male 
in  transmitting  ability,  but  when  he  came  to  revise  his  data 
more  closely,  he  saw  reason  to  conclude  that  the  influence  of 
females  is  but  little  inferior  to  that  of  males  in  such  transmis- 
sion. It  may  be  said  with  equal  truth  probably  both  of  ability 
and  insanity  that  while  transmission  to  the  same  sex  and  trans- 
mission to  the  other  sex  are  common  enough,  the  relative 
frequency  of  their  occurrence  is  yet  uncertain. 

Some  writers  subscribe  to  the  plausible  theory  which  has  come 
down  from  antiquity,  that  madness,  like  other  hereditary  diseases, 
is  most  likely  to  be  transmitted  to  the  child  which  resembles 
most  in  features  and  disposition  the  insane  parent,  and  that  a 
person  who  has  the  misfortune  to  be  so  descended  may  therefore 
take  comfort  to  himself  if  he  is  unlike  that  parent.  However, 
the  conclusion  must  not  be  made  absolute ;  it  does  not  follow 
that  a  child  who  resembles  a  parent  in  features  shall  have  a 
similar  disposition,  since  there  is  assuredly  no  constant  relation 
between  resemblance  of  features  and  of  moral  disposition ;  and 
of  course  it  is  not  where  the  bodily  features  are  alike,  but  where 
the  mental  disposition  is  of  the  same  kind,  that  we  should  expect 
to  observe  such  operation  of  the  law  of  heredity.  I  have  noticed 
too  in  some  cases  that  a  likeness  to  one  parent  or  to  his  or  her 
family  type  which  comes  out  strongly  at  one  period  of  life  may 
wane  gradually  and  be  replaced  by  a  greater  likeness  to  the  other 
parent  or  to  his  or  her  family  type  at  a  later  period  of  life ;  the 
son  who  calls  to  mind  his  mother  at  twenty  years  old  perhaps 
calls  his  father  to  mind  at  forty ;    and  the  daughter  who  was 

1  Hered.  Gen,  p.  63. 


iji.]      THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      119 

like  her  fatlier  at  twenty  puts  on  more  of  her  mother's  simili- 
tude at  forty.  It  is  plain  then  that  a  son  or  a  daughter  who  had 
been  unlike  the  insane  parent  might  as  time  went  on  take  up 
with  the  family  resemblance  a  tendency  to  the  parental  disease.^ 
In  any  case  there  is  no  doubt  that  a  child  born  after  an 
outbreak  of  parental  insanity  is  more  likely  to  suffer  from 
insanity  than  one  that  was  born  before  the  outbreak. 

In  considering  the  period  of  life  at  which  a  hereditary  predis- 
position to  insanity  or  any  other  such  predisposition  will  sho  w 
itself  in  actual  disease,  it  should  be  borne  in  mind  that  certain 
organs  or  systems  of  organs  are  particularly  active  at  certain 
ages,  when  they  will  naturally  be  more  prone  to  fall  into  that 
disordered  action  to  which  they  are  intrinsically  disposed.  In 
like  manner  they  may  be  less  predisposed  to  one  and  more  pre- 
disposed to  another  kind  of  morbid  action  when  their  decay  and 
the  decline  of  their  functions  begin  in  old  age.  In  infancy,  as 
Petit  has  pointed  out,  the  lymphatic  and  the  nervous  systems 
predominate,  for  which  reason  scrofula  ^nd  epilepsy  are  the 
hereditary  diseases  which  then  most  show  themselves.  As 
years  go  on  the  muscular  system  undergoes  great  development, 
the  sexual  organs  begin  their  function,  and  the  whole  vascular 
system  is  very  active ;  wherefore  inflammatory  diseases  are  most 
apt  to  occur,  pulmonary  diseases  to  accompany  or  to  follow 
the  development  of  the  chest,  and  nervous  derangements  of  a 
hysterical  or  allied  nature  to  attest  the  revolution  which 
the  development  of  the  sexual  organs  produces  in  the  entire 
economy.  Before  puberty  nature's  chief  concern  has  been  with 
physical  development ;  but  with  the  new  desires  and  impulses 
which  spring  up  after  puberty,  when  the  individual  life'  begins 
to  expand  into  social  life,  the  mind  undergoes  a  transformation, 

*  A  man  may  get  great  help  in  self-knowledge  sometimes  by  observing 
and  reflecting  on  the  characters  of  the  different  members  of  his  family — 
father,  mother,  uncles,  brothers,  sisters,  &c,,  for  he  may  see  in  them  the 
developed  outcomes  of  hidden  tendencies  in  himself,  the  written-out  expo- 
sition, as  it  were,  of  what  is  understood  in  him.  When  he  cannot  under- 
stand why  he  should  have  acted  in  a  certain  way  on  a  particular  occasion, 
a  trait  in  his  brother's  or  his  child's  character  may  furnish  the  explanation. 
Note  in  this  relation  how  the  same  face  in  different  aspects  and  expres- 
sions suggests  the  features  of  different  members  of  the  family,  and  how  the 
dead  person's  face  sometimes  shows  a  likeness  scarcely  perceived  in  life. 


120  PATHOLOGY  OF  MIND.  Ichap. 

and  tlie  consequence  is  that  hereditary  insanity  may  declare 
itself;  if  not  directly  after  puberty  as  the  result  of  the  natural 
physiological  action  becoming  pathological,  still  in  the  years 
that  immediately  follow  it,  when  the  mind  is  most  tried,  being 
under  a  strain  of  energy  in  the  novel  adjustment  to  the  condi- 
tions of  active  life,  or  when  overworked  in  the  subsequent  years 
of  eager  competition  during  manhood.  Many  men  break  down 
too  in  these  years  from  the  enervating  effects  of  sexual  excesses 
upon  an  excitable  and  feeble  nervous  system,  and  of  course 
women  may  break  down  under  the  trials  of  pregnancy  and  par- 
turition. In  later  manhood  rheumatism  and  gout  attest,  the  former 
perhaps  a  muscular  system  which,  having  reached  the  prime  of 
its  energ}^,  now  discovers  a  strain  of  weakness  or  begins  to 
decline ;  the  latter,  a  decay  of  the  powers  of  assimilation  and 
nutrition  which  is  not  acknowledged  prudently  by  giving  them 
less  to  do.  At  a  more  advanced  age  still  the  abdomen  seems  to 
take  up  the  tale :  the  energy  of  feeling  and  desire,  which  has  its 
physiological  source  in  the  visceral  organs  and  inspires  vigorous 
self-assertion  and  practical  will,  abates  gradually  as  they  become 
dull  and  weary;  the  result  being  a  tendency  to  sombre  and 
gloomy  feelings  which  may  pass  into  hypochondria  and  melan- 
cholia. Lastly  in  old  age  the  tissues  degenerate  and  the  cerebral 
vessels  give  way  in  apoplexy  ;  or  the  brain  shrinks  in  decay  and 
senile  dementia  ensues. 

Consanguineous  Marriages. — Whether  these  marriages  breed 
degenerate  olfspring  is  a  question  which  has  been  much  dis- 
puted, some  writers  having  impugned  the  general  opinion  that 
their  effects  are  bad.  It  is  a  subject  concerning  which  it  is 
difficult  to  make  exact  inquiries,  and  impossible  to  arrive  at 
trustworthy  results  ;  and  Mr.  G.  Darwin,  who  undertook  a  series 
of  painstaking  inquiries  lately,  was  obliged  to  abandon  them 
without  having  reached  conclusions  which  he  could  put  forward 
with  any  confidence ;  so  far  as  they  went,  however,  his  inquiries 
seemed  to  show  that  there  was  not  good  reason  to  declare  that 
such  marriages  had  any  ill  effect.^  Inasmuch  as  the  wisdom  of 
mankind  is  greater  than  the  wisdom  of  any  individual  in  any 
matter  of  common  experience,  wdiere  no  special  means  of 
1  Journal  of  Statistical  Society y  June  1875. 


III.]      THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      121 

observation  have  been  used,  because  the  area  thereof  is  so  mucli 
greater,  the  numerous  springs  which  feed  it  flowing  into  the 
common  receptacle  from  all  quarters  and  in  all  ages,  I  cannot 
help  thinking  that  we  ought  justly  to  attach  great  weight  to  the 
prohibitions  of  intermarriages  of  near  of  kin  which  have  been 
made  by  all  sorts  of  peoples  in  all  times  and  places  :  they  are 
apparently  an  argument  of  the  universal  belief  of  their  ill 
effects.  Amongst  the  lower  races  the  range  of  prohibition  is 
much  greater  than  in  the  civilised  world,  extending  to  the  most 
distant  relatives  by  blood.  Certainly  the  popular  conviction 
nowadays  is  that  such  intermarriages  are  more  prone  than  not- 
akin  marriages  to  breed  idiocy,  insanity,  and  deaf-mutism.  Who- 
soever wishes  to  test  the  opinion  with  animals  let  him  try 
experiments  with  a  select  breed  of  pigs,  breeding  in  and  in  for 
several  generations,  and  never  crossing  them  with  any  strain 
fi'om  without,  and  he  v/ill  find  in  full  time,  if  his  experiments 
coincide  with  mine  accidentally  made  once,  that  his  sow^s  have 
no  young  or  only  two  or  three  at  a  litter,  and  that  they  are 
very  likely  to  savagely  worry  those  which  they  have :  that  he 
must,  if  he  would  go  on  keeping  pigs,  cross  or  change  his  breed. 
For  the  last  dozen  years  or  so  a  record  has  been  kept  of  the 
number  of  mares  among  racers  which  have  proved  barren  or 
have  prematurely  slipped  their  foals;  and  it  deserves  notice, 
Mr.  Darv/in  says,  as  showing  how  infertile  these  highly  nurtured 
and  closely  interbred  animals  have  become,  that  not  far  from 
one  third  of  the  mares  fail  to  produce  living  foals. 

The  main  or  only  argument  w^hich  those  who  reject  the 
popular  belief  put  forward  is  to  point  to  some  remarkable  in- 
stances, such  as  the  celebrated  racehorse  Eclipse,  of  the  higher 
qualities  of  the  kind  in  the  products  of  close  interbreeding. 
Granting  the  special  qualities  developed  in  these  cases  to  be  of 
as  high  a  nature  as  they  are  assumed  to  be,  all  that  the  ex- 
amples really  prove  is  that  sometimes  interbreeding  has  no  bad 
effect ;  they  prove  nothing  with  regard  to  the  question  whether 
the  general  results  of  interbreeding  are  not  bad.  The  lesson 
which  we  ouo'ht  to  learn  from  them  is  to  g^o  beneath  the  j^eneral 
fact  of  interbreeding,  and  to  search  for  those  more  intimate 
and  special  conditions  which  determine  good  results  in  a  few 


122  PATFIOLOGY  OF  MJND.  [chap. 

instances,  and  bad  results  in  many  other  instances  ;  not  to  stay 
satisfied  with  the  bare  experience  of  interbreeding,  but  to  dis- 
cover the  ill  conditions  which,  sometimes  failing,  commonly 
accompany  it. 

A  theory  that  has  been  propounded  to  explain  the  different 
effects  of  interbreeding  is  that  when  there  is  any  strain  of  weak- 
ness in  the  family,  such  as  madness,  or  deafness,  or  consumption, 
it  intensifies  the  bad  elements,  and  so  causes  disastrous  results ; 
wherefore  when  the  sexual  elements  which  combine  are  per- 
fectly sound  and  stable  no  ill  consequences  ensue.  Mr.  Darwin's 
recent  patient  and  careful  inquiries  into  the  effects  of  cross  and 
self-fertilization  in  the  vegetable  kingdom  are  most  instructive 
in  this  relation.  They  have  shown  that  plants  gain  distinct 
advantages  from  cross-fertilization  in  larger  and  better  growth, 
in  increased  capacity  to  resist  adverse  external  circumstances, 
and  in  increased  fertility  ;  and  that  the  introduction  of  a  fresh 
stock  to  remedy  the  evils  of  interbreeding  is  as  marked  in 
plants  as  it  has  long  been  known  by  breeders  to  be  in  animals. 
He  has  come  to  the  conclusion  that  the  advantages  of  cross- 
fertilization  are  the  result,  not  of  any  mysterious  virtue  in  the 
union  of  distinct  individuals,  but  of  the  different  conditions 
to  which  the  individuals  have  been  subjected  during  pre- 
vious generations,  and  to  the  differentiations  which  have  been 
thereby  produced  in  them  ;  for  he  has  noticed  that  cross-fertili- 
zation by  plants  that  have  been  in  similar  external  conditions 
is  not  beneficial.  From  want  of  such  differentiations  he  believes 
it  is  that  self-fertilization  works  injuriously.  Applying  this 
doctrine  to  the  interbreeding  of  animals  we  shall  conclude 
that  the  bane  of  near-akin  intermarriages  springs — first,  from  the 
persons  having  inherited  similar  peculiarities  of  nature,  and, 
secondly,  from  their  having  been  brought  up  in  similar  external 
conditions,  whereby  the  peculiarities  have  been  fostered  and  no 
variation  has  been  elicited.  This  being  so,  it  is  plain  that  the 
results  need  not  always  be  bad ;  if  there  are  innate  essential 
differences  between  cousins,  or  if,  not  being  much  different 
essentially,  they  have  been  bred  and  reared  in  very  different 
conditions,  there  will  be  such  wholesome  differentiations  of 
natures  as  to  obviate    any  tendency   to   the   exaggeration    of 


III.]      THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       123 

peculiarities  by  intermarriage,  and  the  results  may  be  excellent. 
Breeders  are  accustomed  to  separate  male  and  female  animals 
of  the  same  offspring  early  in  life,  and  to  put  them  in 
widely  different  conditions,  when  they  intend  them  to  inter- 
breed; then  they  get  good  results.  This  agrees  with  the 
aphorism  of  Hippocrates,  that  we  ought  to  change  the  constitu- 
tions of  individuals  in  order  to  prevent  the  diseases  to  which 
they  are  hereditarily  predisposed,  which  is  to  be  done,  he 
says,  by  placing  them  in  different  circumstances  from  those 
by  which  their  parents  were  surrounded. 

It  will  not  be  amiss  to  bear  in  mind,  when  drawing  con- 
clusions from  observation  of  the  results  of  animal  interbreeding, 
that  the  breeder's  object  often  is  to  exaggerate  and  fix  a  parti- 
cular variation  or  peculiarity  of  the  animal  which  is  advanta- 
geous not  to  it,  but  to  him,  or  only  to  it  through  him,  not  to 
breed  the  completest  animal  of  its  kind,  or  to  cultivate  a  varia- 
tion which  micjht  suit  the  animal  best :  a  racehorse  is  not  fit  for 
much  else  besides  racing,  nor  a  certain  breed  of  sheep  fit  for 
much  else  except  to  get  fat  upon  turnips.  We  cannot  apply  that 
principle  incontinently  to  human  beings,  in  whom  on  the  whole 
it  would  seem  best  not  to  exaggerate  a  particular  quality,  but 
to  breed  as  complete  a  nature  as  possible,  a  being  capable  of 
fair  development  all  round. 

Another  caution  may  fitly  be  suggested— namely,  to  take 
heed  not  to  over-estimate  the  range  of  the  limited  differentia- 
tions which  different  conditions  of  life  can  produce,  within  the 
terms  of  their  lives,  in  two  persons  of  the  same  family  whose 
natures  are  alike  fundamentally  ;  for  development  can  only  pro- 
ceed upon  the  lines  laid  in  the  nature,  following  its  radical 
tendencies,  and  all  variations  which  different  external  con- 
ditions can  produce  will  be  superficial  and  transitory,  having 
small  influence  in  interbreeding  compared  with  the  deep  and 
permanent  sameness  of  nature.  Try  as  hard  as  one  can  to 
quell  nature,  one  cannot  quench  it ;  it  will  come  out  in  the 
critical  moments  of  life,  and  will  show  itself  in  hereditary 
transmission.  It  is  possible  that  a  man  may  resemble  his  aunt 
more  than  his  father  or  mother,  and  that  his  female  cousin, 
whose  mother  the  aunt  is,  may  be  very  like  her  mother  ;  and  if 


124  PATHOLOGY  OF  MIND.  [cHAr. 

they  two  many,  the  result  might  conceivably  be  as  bad  as  if 
brother  and  sister  married  ;  but  if  the  two  were  as  unlike  as 
two  persons  who  were  not  in  the  least  akin  to  one  another,  by 
reason  of  their  representing  different  lines  of  the  ancestral 
pedigree,  then  there  might  be  little  or  no  risk.  Even  in  that 
case,  however,  it  is  proper  to  remember  what  has  been  said  con- 
cerning the  latency  of  qualities  in  the  individual  of  one  genera- 
tion which  may  nevertheless  blossom  in  his  offspring  ;  and  the 
possibility  that  the  union  of  two  unlike  cousins  might  chance  to 
issue  in  the  development  of  some  of  these  latent  like  qualities. 
Prudence  would  dictate  the  avoidance  of  intermarriages  of  near- 
a-kin  in  all  cases,  and  particularly  so  in  those  cases  in  which 
there  is  not  distinct  evidence  of  radical  differences  so  great  as 
those  which  there  are  between  persons  not  in  the  least  related 
to  one  another. 

This  theory  of  the  mode  of  operation  of  interbreeding  agrees 
with  what  was  previously  said  concerning  the  sexual  union  of 
unsuitable  natures  who  were  not  related  to  one  another  by 
kinship.  When  two  persons  of  mean,  suspicious,  and  distrust- 
ful character  marry  they  are  likely  to  intensify  the  antisocial 
peculiarity,  which  may  culminate  in  such  a  want  of  balance  in 
the  offspring  that  he  cannot  mix  at  all  with  his  kind,  is  a  com- 
plete discord  in  nature.  In  like  manner  when  marriage  takes 
place  between  two  persons  of  an  intense  but  narrow  artistic  or 
poetic  temperament,  whose  thin  idealistic  aspirations,  miscalled 
great  imagination,  are  not  informed  by  that  sincere  and  whole- 
some converse  with  realities  which  lays  up  a  capital  of  sober 
sense — in  whose  minds  the  emotional  element  has,  so  to  speak, 
run  to  seed — they  are  likely  enough  to  breed  an  unstable  pro- 
duct, which  may  be  looked  upon  as  a  pathological  evolution  of 
their  natures.  The  further  misfortune  is  that  the  natural 
tendency  to  an  intensification  of  the  neurotic  type,  declaring 
itself  by  a  sympathy  of  feelings,  tastes,  and  pursuits,  draws  such 
persons  to  cultivate  each  other's  society  and  so  to  fall  in  love 
and  marry.  Or  if  a  person  of  this  temperament  should  marry 
a  woman  of  sounder  and  more  sober  temperament  who  takes  a 
wholesome  view  of  the  exigencies  and  enjoyments  of  life,  his 
narrow  self-feelinc*-  will  be  much  hurt/  he  will  wail  at  what  he 


111.]      THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       125 

suffers  from  want  of  sympathy  and  of  appreciation,  and  will 
perhaps  separate  from  his  wife  on  the  ground  of  incompatibility. 
Then  again  these  persons  choose  by  a  natural  affinity  those 
external  circumstances  of  life  which  are  suited  to  foster  rather 
than  to  check  the  special  tendencies  of  their  natures,  not 
enduring  repugnant  circumstances  and  getting  the  benefit  of 
them  in  wholesome  discipline  and  self-culture,  as  a  sounder  and 
wiser  nature  would ;  they  solicit  not  differentiations  but  in- 
tensify peculiarities  of  nature  until  these  become  pathological. 
They  do  consciously,  in  fact,  what  is  done  blindly  when  family 
peculiarities  are  intensified  by  intermarriages  of  near  of  kin. 
Lastly,  they  mismanage  their  children  as  they  mismanage  them- 
selves, training  them,  wittingly  or  unwittingly,  along  the  lines 
of  their  abnormal  tendencies.  No  wonder,  after  such  prepara- 
tion and  training,  that  a  being  is  developed  eventually  of  so 
irregular  and  unstable  a  nature  that  he  is  practically  a  morbid 
element  and  can  take  no  part  in  the  functions  of  the  social 
organism. 

Those  who  have  made  a  study  of  the  causes  of  deaf-mutism 
are  satisfied  of  the  ill  effects  of  blood-kinship  of  parents.  Some 
affirm  that  there  are  more  cases  of  congenital  deafness  from 
the  marriage  of  first  cousins  than  from  all  other  causes  put 
together ;  while  others  think  congenital  deafness  in  one  or 
both  parents  a  more  fruitful  source  of  congenital  deafness  than 
any  other.  Certain  it  is  that  it  is  a  common  thing,  when 
enquiring  about  the  relatives  of  pupils  in  the  different  institu- 
tions for  the  deaf  and  dumb,  to  hear  that  a  parent,  or  an  uncle, 
or  an  aunt,  or  a  cousin  was  congenitally  deaf.  It  is  obviously 
in  those  cases  in  which  there  is  a  tendency  to  deafness  in  the 
family  that  the  marriage  of  first  cousins  will  be  most  in- 
jurious, because  it  will  be  likely  to  intensify  the  defect,  but 
why  such  intermarriage  by  itself,  when  there  was  no  tendency 
to  deafness  in  the  family,  should  occasion  it,  we  know  not  any 
more  than  we  know  in  the  least  why  blue-eyed  cats  should  be 
deaf.  There  are  correlations  of  organic  structure  and  function, 
physiological  and  pathological,  which  we  must  be  content  to 
observe  and  note  for  the  present  without  bein<;^  able  to  give  the 
least  explanation  of  them.     Deaf  persons  are  prone  to   marry 


lii6  PATHOLOGY  OF  MIND.  [CH.  in. 

those  who  are  similarly  afflicted  ;  being  unable  to  mix  com- 
fortably with  persons  who  can  hear,  they  are  drawn  to  others 
like  themselves  with  whom  they  can  converse  on  equal  terms, 
and  so  intermarry,  propinquity  and  sympathy  breeding  love,  and 
transmit  the  evil  from  generation  to  generation.  The  advocates 
of  the  "  German "  system  of  teaching  and  training  the  deaf 
and  dumb — the  system  which  is  based  upon  articulation  and 
lip  reading — claim  one  advantage  of  it  to  be  that  it  tends 
to  prevent  such  intermarriages,  as  it  enables  the  deaf  to  ap- 
prehend what  is  said  by  perception  of  the  movements  of  the 
lips,  and  so  to  mix  better  with  their  fellow- creatures.  In  like 
manner,  it  is  a  right  training  to  remove  a  person  of  an  in- 
sane temperament  from  habitual  intercourse  with  a  person  of  a 
similar  temperament,  and  to  subject  him  to  quite  other  external 
influences,  inasmuch  as  the  change  is  fitted,  by  fostering 
variations  of  character,  to  produce  a  more  stable  nature,  and,  by 
widening  his  circle  of  social  intercourse,  to  lessen  the  proba- 
bility of  marriage  with  a  similarly  constituted  person. 

With  these  remarks  concerning  consanguineous  marriages  I 
pass  from  the  consideration  of  the  antecedent  conditions  which 
lay  the  foundation  of  a  predisposition  to  insanity  in  the  indi- 
vidual, and  go  on  to  consider  the  conditions  of  life  which 
favour  its  development.  One  may  take  it  to  be  broadly  true 
that  the  circumstances  which  augment  a  predisposition  to  in- 
sanity, so  that  the  disease  ultimately  breaks  out,  are  just  the 
circumstances  which  are  calculated  to  generate  it  de  novo — 
namely,  all  those  things  which  help  to  put  an  individual  out 
of  healthy  relations  with  his  social  and  physical  surroundings. 


CHAPTER   IV. 

THE    CAUSATION   AND    PEEVENTION    OF   INSANITY    (continued). 

Conditions  of  Life. — In  dealing  witli  the  subjects  wliicli  may 
be  brought  under  this  comprehensive  heading  it  will  be  necessary 
to  be  as  brief  and  concise  as  is  consistent  with  clearness. 

A  question  has  been  much  discussed,  and  is  not  yet  settled 
satisfactorily,  whether  insanity  has  increased  with  the  progress 
of  civilisation  and  is  still  increasing  in  the  community  out 
of  proportion  to  the  increase  of  the  population.  Travellers 
are  agreed  that  it  is  a  disease  which  they  seldom  meet  with 
amongst  barbarous  peoples.  But  that  is  no  proof  that  it  does 
not  occur.  Among  savages  those  who  are  weak  in  body  or 
in  mind,  the  sick  and  the  helpless,  who  would  be  a  burden 
to  the  community,  are  often  eliminated,  being  either  killed 
or  driven  into  the  bush  and  left  to  perish  there  ;  certainly  the 
weak  units  are  not  carefully  tended,  as  they  are  among  civilised 
nations.  In  this  way  not  only  is  the  amount  of  existing  insanity 
rendered  small,  but  its  propagation  to  the  next  generation  is 
prevented.  Admitting  the  comparative  immunity  of  uncivilised 
peoples  from  insanity,  it  is  not  difficult  to  conceive  reasons  for  it. 
On  looking  at  any  table  which  sets  forth  the  usual  causes  of  the 
disease,  we  find  that  hereditary  predisposition,  intemperance, 
and  mental  anxieties  of  some  kind  or  other  cover  nearly  the 
whole  field  of  causation.  From  these  three  great  classes  of 
causes  savages  are  nearly  exempt.  They  do  not  intermarry, 
the  prohibition  of  marriage  extending  among  them  to  distant 
blood-relations,  and,  as  I  have  just  pointed  out,  they  do  not 
much   propagate  the  disease  from  one  generation  to  another, 


128  PATHOLOGY  OF  MIND.  [chap. 

because  it  is  got  rid  of  to  a  great  extent  among  them  by  natural 
or  artificial  means  of  elimination.  Secondly,  they  do  not 
poison  their  brains  with  alcohol,  at  any  rate  not  until  the 
white  man  brings  it  to  them;  when  they  do  obtain  it,  they  no 
doubt  abandon  themselves  to  great  debauches,  but  they  cannot 
obtain  the  regular  supply  which  would  enable  them  to  keep 
their  brains  day  after  day  in  a  state  of  artificial  excitement ; 
and  it  may  fairly  be  questioned  whether  alcohol,  however  and 
in  whatever  quantities  it  may  be  taken,  is  so  likely  to  produce 
mental  derangement  in  the  undeveloped  brain  of  a  savage, 
which  has  so  little  mental  function  to  perform,  as  in  the  more 
complex  and  specialized  structure  of  a  civilised  brain.^  Lastly, 
the  savage  has  few  and  simple  wants  springing  from  his  appetites, 
and  them  he  gratifies :  he  is  free  from  the  manifold  artificial 
passions  and  desires  which  go  along  with  the  multiplied  indus- 
tries, the  eager  competitions,  the  social  ambitions  of  an  active 
civilisation ;  he  is  free  too  from  the  conventional  restraints  upon 
his  natural  passions  which  civilisation  imposes,  and  suffers  not 
from  a  conflict  between  urgent  desire  of  gratification  and  the 
duty  to  suppress  all  manifestations  thereof,  a  conflict  which 
sometimes  proves  too  great  a  strain  upon  the  mind  of  a  civilised 
person. 

On  the  other  hand,  it  may  be  thought  that  the  savage 
must  suffer  ill  consequences  from  the  unrestrained  indulgence  of 
his  fierce  sensual  passions.  But  it  might  not  be  amiss  to  con- 
sider curiously  whether  savage  nudity  provokes  sensuality  so 
much  as  civilised  dress,  especially  dress  that  is  artfully  designed 
to  sugo^est  what  it  conceals.  There  is  no  scope  for  the  imagina- 
tion where  nothing  is  concealed  and  suggested,  and  it  may  be  that 
clothino'  is  sometimes  a  stimulus  to  immodest  thoughts,  and  that, 
like  the  conventional  covering  of  the  passions,  it  inflames  desire. 
Be  that  as  it  may,  the  savage  is  not  disquieted  by  fretting  social 
passions:  with  him  there  is  no  eager  straining  beyond  his 
strength  after  aims  that  are  not  intrinsically  worth  the  labour 

1  Cameron,  in  his  Journey  across  Africa,  says  that  he  met  with  one  man 
only  who  was  suffering  from  delirium  tremens  :  it  was  the  only  instance 
of  this  disorder  which  he  saw  in  Africa,  thoug'h  drunkenness  was  common. 
The  supply  of  pombe,  the  intoxicating  liquor,  often  falls  short,  because  the 
corn  from  which  they  make  it  is  not  abundant. 


IV.]       THE  CAUSATION  AND  PKEVENTION  OF  INSANITY.       129 

and  vexations  which  they  cost,  no  disappointed  ambition  from 
failure  to  compass  such  aims,  no  gloomy  dejection  from  the 
reaction  which  follows  the  successful  attainment  of  an  over- 
rated ambition,  no  pining  regrets,  no  feverish  envy  of  com- 
petition, no  anxious  sense  of  responsibility,  no  heaven  of 
aspiration  nor  hell  of  fulfilled  desire  ;  he  has  no  life-long 
hypocrisies  to  keep  up,  no  gnawing  remorse  of  conscience  to 
endure,  no  tornieutiucf  reflections  of  an  exae^ferated  self- 
consciousness  ;  he  has  none,  in  fact,  of  the  complex  passions 
which  make  the  chief  wear  and  tear  of  civilised  life.  His 
conscience  is  a  very  primitive  affair,  being  no  more  than  a 
sense  of  right  attaching  to  the  beliefs  and  customs  of  his  tribe, 
but  such  as  it  is  he  seldom  goes  against  it ;  he  may  cheat,  lie, 
steal,  violate  all  the  dictates  of  a  true  moral  sense,  especially 
in  his  relations  with  the  members  of  other  tribes ;  but  he  obeys 
his  tribal  conscience,  as  the  animal  obeys  its  instinct,  without 
feeling  a  temptation  to  violate  it.  He  is  extraordinarily  con- 
servative, the  custom  of  his  fathers  being  for  him  the  fullest 
justification  of  any  belief  or  practice,  however  monstrous  or 
irksome ;  he  is  free  therefore  from  the  perils  which  to  unstable 
natures  lie  in  the  excitement  produced  by  revolutionary  change 
and  in  the  adjustment  to  new  relations  exacted  thereby.  So  it 
comes  to  pass  that  he  is  not  subject  to  the  powerful  moral 
causes  of  mental  derangement  which  act  upon  the  civilised 
person,  and  that  he  cannot  suffer  from  some  of  the  forms  of 
derangement  which  afflict  the  latter. 

These  considerations  favour  the  accepted  notion  that  insanity 
is  less  common  among  uncivilised  than  among  civilised  peoples, 
and  that  there  is  an  increased  liability  to  mental  disorder  going 
along  with  an  increase  in  the  complexity  of  the  mental  organiza- 
tion. Certainly  it  is  in  accordance  with  common  sense  to 
suppose  that  a  complex  machine,  like  the  civilised  brain,  which 
is  constructed  of  many  special  and  delicate  parts  working 
together  in  the  most  nicely  adjusted  relations,  will  be  exposed 
to  more  risk  of  derangement  of  action  and  be  more  likely  to 
go  wrong  than  a  simpler  and  coarser  machine,  the  less  various 
parts  of  wdiich  have  less  fine  and  complicated  relations.  As 
there   is  a  greater  liability  to  disease   and   the  possibility  of 


130  PATHOLOGY  OF  MIND.  [chap. 

many  more  diseases  in  a  complex  organism  like  the  human  body, 
where  there  are  many  kinds  of  tissue,  an  orderly  subordination 
of  parts,  and  a  working  of  the  whole  in  every  part  and  of  every 
part  in  the  whole,  than  in  a  simple  organism  where  there  is 
little  differentiation  and  less  complexity  of  structure ;  so  in  the 
complex  mental  organization  having  the  manifold  special  and 
complex  relations  with  the  external  which  a  state  of  civilisation 
implies  there  are  plainly  the  occasions  of  more  easily  produced 
and  more  varied  derangements  than  in  the  comparatively  simple 
mental    organization  of   the   savage.      We  might   expect  that 
mental  sufferings  would  be  as  few  and  simple  in  an  infantile 
stage  of  society  as  they  are  in  the  infancy  of  the  individual, 
and  the   morbid   outcomes  of  them   as  few  and  simple   also. 
The  native  Australian,  who  has  not  in  his  language  any  words 
for  vice  and  justice,  nor  in  his  life  any  true  moral  relations, 
having  no  such  ideas  as  the  words  express  and  no  such  senti- 
ments  as   social    relations    stir    in   an    ordinarily   intelligent 
European,   cannot   ever    present   an   example   of    true    moral 
insanity ;    before  he  can  undergo  such  moral  degeneration  he 
must  first  be  humanized  and  then  civilised ;  mental  organiza- 
tion  must   precede  mental  disorganization.^     That   degenerate 
nervous  function  in  young  children  manifests  itself  in  convul- 
sions rather  than  in  mental  disorder ;  that  the  lower  animals 
seldom  suffer  from  mental  disorder ;  that  it  is  of  comparatively 
rare   occurrence  among  savages,  and  that  it  takes  one  of  two 
or  three   simple  forms  when  it  does  occur  among  them — are 
facts  which  are  owing  to  one  and  the  same  cause,  namely,  a 
want  of  development  of  the  mental  organization.     As  is  the 
height  so  is  the  depth,  they  are  opposite  and  equal :  with  the 
progress  of  mankind  to  a  higher  stage  of  evolution  there  are  cor- 
relative possibilities  of  retrograde  change  ;  the  weaker  members 
who  cannot  bear  the  strain  of  progress  will  fall  by  the  wayside ; 
and  an  increased  quantity  as  well  as  an  increased  variety  of 

^  A  particular  sense,  it  is  true,  may  be  more  acute  in  a  savage  than  in 
a  civilised  person,  e.g.  sight,  hearing,  or  smell,  as  is  the  case  also  in  the 
animal  ;  but  neither  in  savage  nor  animal  has  any  one  of  these  senses  the 
delicate  shades  and  varieties  of  susceptibility  which  it  has  in  the  civilised 
person,  who  may  accordingly  have  varieties  of  hallucinations  of  them, 
when  disordered,  which  the  savage  cannot  have. 


IV.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      131 

mental  derangement  will  bear  witness  that  tlie  individual 
perishes,  while  the  race  grows  more  and  more. 

Kising  some  steps  higher  than  savages  to  a  people  which, 
having  long  ago  reached  a  certain  level  of  civilisation,  has  ever 
since  remained  stationary  at  it,  we  find  it  stated  that  though 
diseases  of  the  nervous  system  are  by  no  means  uncommon 
among  the  Chinese,  cases  of  mental  alienation  are  comparatively 
few — that  is  to  say,  if  suicides  are  not  counted  as  madness ; 
for  the  Chinese  will  go  to  his  death  by  suicide  as  quietly  and 
methodically  as  he  would  go  to  his  bed.^  Perhaps  this  in- 
frequency  of  insanity  is  what  might  have  been  expected  from 
the  natural  character  of  the  Chinaman,  who  is  placid,  steady, 
equable,  nowise  disquieting  himself  about  business,  religion,  or 
politics,  but  doing  his  work  in  a  calm  methodical  way,  and 
accepting  good  or  ill  fortune  alike  with  equanimity.  It  must 
be  borne  in  mind,  however,  that  lunatics  are  very  harshly 
treated  in  China,  being  usually  tied  up,  sadly  neglected,  and 
cruelly  used  by  their  friends  and  relations ;  and  this  sort  of 
treatment  cannot  fail  to  lessen  the  number  of  existing  cases, 
apart  from  any  question  as  to  the  number  of  occurring  cases. 

Alarming  statements  are  often  made  concerning  the  rapid 
increase  of  insanity  which  is  supposed  to  be  going  on  year  by 
year  in  civilised  countries ;  and  the  figures  which  are  quoted 
certainly  look  formidable.  In  1844  there  were  in  England  and 
Wales  20,611  registered  insane  persons ;  in  1859  the  number 
had  risen  to  36,762  ;  in  1869  it  was  53,177 ;  and  on  the  1st 
January,  1878,  it  was  68,538.  Or,  calculating  the  proportion  of 
idiots  and  lunatics  to  the  increasing  population,  it  was,  in  1859, 
18-67  to  10,000 ;  in  1869,  23'93 ;  on  the  1st  January,  1878, 
27*57.2  The  broad  truth  is  that  there  is  about  one  registered 
insane  person  to  365  of  the  population  now,  while  the  propor- 
tion in  1859  was  one  in  540.  The  very  greatness  of  this 
increase,  however,  might  well  raise  a  suspicion  that  it  has  not 
been  due  mainly  to  an  increased  production  of  insanity  in  the 
population ;  for  whether  the  course  of  human  events  during  the 
last  quarter  of  a  century  has  been  good  or  bad,  it  certainly  has 

^  Journal  of  Mental  Science,  1875,  p.  31. 

2  Thirty- Second-  Beport  of  the  Lunacy  Commissioners,  1878. 


132  PATHOLOGY  OF  MIND.  [chap. 

not  differed  so  mucli  from  tliat  of  former  times,  or  differed  so 
much  and  so  capriciously  daring  the  quarter  of  a  century,  as 
such  a  difference  in  the  quantity  of  insanity,  were  it  due  to  it, 
would  mean.  Without  doubt  the  main  part  of  this  increase  is 
owing  to  the  more  stringent  regulations  which  from  time  to  time 
have  been  made  and  enforced  for  the  registration  and  protection  of 
insane  persons,  whereby  many  that  were  never  heard  of  officially 
at  one  time  are  now  duly  registered  and  counted.  When  the 
admissions  of  each  year  into  asylums  are  examined,  which  re- 
present pretty  fairly  the  numbers  of  occurring  cases,  it  is  observed 
that  a  marked  rise  in  the  numbers  has  followed  the  enactment 
of  some  new  Act  of  Parliament,  the  direct  effect  of  which  has 
been  to  force  insane  paupers  into  asylums  :  the  increase  has  not 
been  steadily  progressive,  but  has  taken  place  rather  by  leaps 
and  bounds  which  have  answered  the  stimulus  of  each  fresh 
parliamentary  enactment.  It  will  be  noted  furthermore  that 
the  increase  is  mainly  among  paupers,  since  the  ratio  of  private 
lunatics  to  the  population  (per  10,000)  has  been  as  follows : — 


Year — 

1859. 

1865. 

1873. 

1874. 

1875. 

1876. 

1877. 

1878. 

Males 

2-81 

3-16 

3-43 

3-49 

3-47 

3-44 

3-42 

3-45 

Females 

2-26 

2-34 

2-61 

2-69 

272 

2-77 

2-78 

2-76 

Total  2-5        274        3-01         3-08        3-09        3-10        3-09        3-09 

Thus  there  has  been  little  change  during  the  last  five  years — an 
increase  of  only  half  a  lunatic  in  10,000  persons  since  1859. 

On  examining  the  admissions  of  private  patients  each  year 
and  calculating  their  ratio  to  the  increasing  population  of  the 
country,  it  will  be  found  that  the  figures  do  not  point  to  a 
steadily  increased  production  of  insanity  in  the  non-pauper 
class ;  and  they  are  the  more  significant  when  it  is  borne  in 
mind  that  the  more  numerous  and  powerful  causes  which  are 
supposed  to  be  at  work  to  augment  the  liability  of  the  com- 
munity to  mental  disease  will  affect  the  classes  from  which 
private  patients  come  at  least  to  an  equal  degree  with,  and 
probably  to  a  greater  degree  than,  the  classes  which  supply  the 
pauper  patients.  It  cannot  be  said  that  they  yield  real  support 
to  the  opinion  of  the  alarmists  that  so  many  more  persons  go 
mad  now  than  in  the  days  of  our  grandfathers. 


IV.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       133 

Agricultural  counties  furnish  a  larger  proportion  of  lunatics 
than  manufacturing  districts,  and  those  counties  in  which  the 
wages  are  low,  like  Wilts,  a  larger  proportion  than  those  in 
which  the  wages  are  high.  Low  wages  of  course  mean  poverty 
and  bad  nourishment,  and  lunacy  shows  a  distinct  tendency  to 
go  hand  in  hand  with  pauperism.  Moreover  the  stagnant,  un- 
intellectual  life  of  an  a2;ricultural  labourer  is  less  conducive  to 
mental  health  than  the  more  active  and  varied  intellectual  life 
evoked  by  the  pursuits  and  mterests  of  a  manufacturing  town, 
^lental  exercise  is  the  true  foundation  of  mental  health  ;  and 
when  a  person  who  by  virtue  of  being  born  of  civilised  parents 
has  inherited  the  mental  organs  and  aptitudes  fitting  him  for  a 
certain  height  and  variety  of  moral  and  intellectual  development, 
makes  no  use  of  them,  but  allows  them  to  w^aste  and  degenerate, 
so  initiating  decay  of  his  higher  nature,  he  is  in  favourable 
conditions  for  the  occurrence  of  some  form  or  other  of  more 
positive  mental  derangement.  He  is  not  like  the  savage  who, 
having  no  such  inheritance,  suffers  not  any  ill  consequences 
from  mental  stagnation ;  being  the  heir  to  ages  of  culture,  he 
has  the  responsibilities  of  his  inheritance ;  he  cannot  divest  liis 
nature  of  the  privileges  of  its  higher  birth,  nor  himself  of  the 
duty  to  exercise  them  fitly,  nor  exempt  himself  or  his  posterity 
from  the  sure  penalties  of  neglect  of  them. 

The  candid  observer  who  surveys  the  ways  of  men  in  the 
state  of  modern  civilisation  cannot  choose  but  confess  that 
many  of  their  most  cherished  aims  are  unw^orthy  of  the  zeal 
and  energy  with  which  they  are  pursued.  They  may  be  summed 
up  compendiously  in  the  words  ''  to  get  on  in  the  world,"  by 
w^hich  is  mostly  meant  to  get  rich  and  to  rise  a  step  or  two  in 
the  social  scale.  Without  doubt  it  is  a  oood  and  excellent 
thing  that  there  should  be  so  much  desire  and  energy  displayed 
in  straining  for  an  aim  of  some  sort,  forasmuch  as,  were  there 
not,  no  progress  could  be  made ;  but  it  is  often  a  grievous  thing 
as  regards  the  individual  and  his  family  that  his  aims  and  work 
are  not  more  consciously  and  systematically  altruistic ;  that  he 
does  not  realise  plainly  that  he  is  a  member  of  a  social  body 
whose  individual  functions  are  subordinate  to  the  welfare  of  the 
whole.     His  practical  worship  being  to  get  money  and  enjoy  it, 


134  PATHOLOGY  OF  MIND.  [chap. 

attested  as  real  religion  is,  by  faitli  and  works,  and  liis  professed 
religion,  not  attested  by  faitli  and  works,  being  to  despise  the 
things  of  this  world  and  to  look  upon  his  sojourn  in  it  as  merely 
a  preparation  and  a  discipline  for  a  life  to  come,  his  actual  aim 
is  to  serve  tw^o  masters  who  require  quite  opposite  services, 
holding  to  the  one  without  despising  the  other.  Unhappily  for 
success  in  this  course,  such  a  divided  allegiance  has  been  pro- 
nounced by  high  authority  to  be  impossible ;  and  the  result  of 
the  radical  inconsistency  of  aims  is  a  want  of  fundamental 
harmony  and  sincerity  of  nature,  which  is  a  poor  defence  against 
the  assaults  of  adversity :  like  a  house,  the  foundations  of  which 
are  not  solidly  laid  on  one  consistent  plan,  it  will  be  likely  to 
fall  when  the  storm  comes.  A  sincere  and  searching  examina- 
tion of  the  quality  of  the  aims  upon  which  he  concentrates  the 
real  hopes,  aspirations,  and  energies  of  his  life,  and  of  the 
foundations  of  the  beliefs  which,  professing,  he  does  not  act 
upon,  and  of  those  which,  professing  not,  he  does  act  upon, 
were  he  capable  of  it,  could  not  fail  to  reveal  to  many  a 
one  how  unstable  is  the  foundation  of  his  mental  structure, 
and  how  ill  fortified  it  is  to  withstand  the  stealthy  advances 
and  direct  onslaughts  of  disease. 

It  cannot  be  disputed  that  the  pursuit  in  which  a  man  is 
engaged  habitually,  which  is  ever  in  his  thoughts,  and  to  suc- 
cess in  wdiich  he  bends  all  his  energies,  does  modify  his  character, 
and  that  the  reaction  upon  character  of  a  life  spent  solely  in 
the  business  of  getting  rich  is  hurtful.  It  is  not  only  that 
the  fluctuations  of  fortune  sometimes  disturb  or  overthrow  the 
balance  of  a  mind  that  is  engaged  in  large  speculations,  or 
that  failure  in  some  great  crisis,  frustrating  the  hopes  and  the 
work  of  a  life,  prostrates  the  individual's  energies  and  drives  him 
melancholic,  but  it  is  that  the  narrow  selfishness  of  his  life-aim, 
sapping  with  steady  certainty  the  feelings  and  responsibilities 
of  a  larger  human  brotherhood  than  mere  family  clannishness, 
weakens  and  withers  the  altruistic  elements  of  his  nature,  and 
so  in  his  person  deteriorates  the  nature  of  humanity.  There  is 
no  more  efficient  cause  of  mental  degeneracy,  perhaps,  than  the 
mean  and  vulgar  life  of  a  tradesman  whose  soul  is  set  entirely 
upon  petty  gains;  who,  under  the  sanction  of  the  customs  of 


IV.]       THE  CAUSATION  AND  PBEVENTION  OF  INSANITY.      135 

his  trade,  practises  systematic  fraud  and  theft ;  and  who  thinks 
to  outweigh  the  iniquities  of  the  week  by  the  sanctimonious 
observance  of  the  Sabbath.  Such  an  one  is  not  likely  to  beget 
children  of  sound  moral  constitution ;  and  for  him  to  hope  to 
found  a  family  which  shall  last  is  little  better  than  to  hope  to 
build  on  quicksand  a  house  which  shall  stand.  The  deteriora- 
tion of  nature  which  he  has  acquired  will,  unless  a  healthier 
female  influence  chance  to  countervail  it,  be  transmitted  as  an 
evil  heritage  to  his  children,  and  show  itself  in  some  form  of 
moral  or  intellectual  deficiency ;  perhaps  in  extreme  duplicity 
and  vice,  perhaps  in  outbreaks  of  positive  insanity. 

The  maxims  of  morality  which  were  proclaimed  by  holy  men 
of  old  as  lessons  of  religion  indispensable  to  the  well-being  and 
stability  of  families  and  nations,  are  not  really  wild  dreams  of 
inspired  fancy,  nor  the  empty  words  which  preachers  make 
them ;  founded  on  a  sincere  recognition  of  the  laws  of  nature 
working  in  human  events,  they  were  visions  of  eternal  truths 
of  human  evolution.  Assuredly  the  "  everlasting  arms "  are 
beneath  the  upright  man  who  dealeth  uprightly,  but  they  are 
the  everlasting  laws  of  nature  which  sustain  him  who,  doing 
that  which  is  lawful  and  rioht,  leads  a  life  that  is  in  faithful 
harmony  with  the  laws  of  nature's  progress ;  the  destruction 
which  falls  upon  him  who  dealeth  treacherously  and  doeth 
iniquity,  "  observing  not  the  commandments  of  the  Lord  to 
obey  them,"  are  the  avenging  consequences  of  broken  natural 
laws.  How  long  will  it  be  before  men  perceive  and  acknow- 
ledge the  eternity  of  action,  good  or  ill,  and  feel  the  keen  sense 
of  responsibility  and  the  strong  sentiment  of  duty  which  so 
awful  a  reflection  is  fitted  to  engender  ?  How  long  before  they 
realise  vividly  that  under  the  reign  of  law  on  earth  sin  or  error 
is  inexorably  avenged,  as  virtue  is  vindicated,  in  its  consequences, 
and  take  to  heart  the  lesson  that  they  are  determining  by  their 
conduct  in  their  generation  what  shall  be  predetermined  in  the 
constitution  of  the  generation  after  them  ?  Crime,  vice,  mad- 
ness, every  unwelcome  sort  of  ill- doing,  comes  by  law,  not  by 
chance,  not  by  casualty  but  by  causality :  "  Shall  there  be  evil 
in  a  city,  and  the  Lord  hath  not  done  it  ? " 

Religion. — Among  the  conditions  of  life  which  have  a  vital 

7 


136  PATHOLOGY  OF  MIND.  .     [ch\f. 

influence  upon  cliaracter,  either  to  strengthen  or  to  weaken  it, 
must  be  reckoned  the  religious  atmosphere  in  which  a  person  is 
born  and  reared.  The  mighty  question  of  the  working  of  reli- 
gion generally,  apart  from  any  particular  form  of  religion,  upon 
the  minds  of  men  for  good  or  evil  I  forbear  to  enter  seriously 
upon,  not  only  because  of  the  difficulty  and  delicacy  of  the  sub- 
ject, but  because  it  would  be  impossible  to  do  justice  to  a  matter 
of  such  transcendent  importance  in  a  brief  and  incidental  manner, 
even  were  the  occasion  and  the  ability  ready.  In  the  outset  it 
would  be  necessary  to  consider  what  effect  a  belief  in  the  super- 
natural, as  almost  universally  harboured  by  mankind,  has  had 
upon  the  growth  and  development  of  human  thought  and  upon 
the  formation  of  human  character ;  whether  its  tendency  on  the 
whole  has  been  and  is  now  to  strengthen  the  understanding  and 
to  further  its  development,  or  to  weaken  and  stunt  it.  When 
one  looks  at  the  desolating  effects  of  superstitious  customs  based 
upon  beliefs  in  the  supernatural  among  savages  at  the  present 
day,  which  must  plainly  shut  out  any  chance  of  progress  so  long 
as  they  last,  and  must  from  the  first  have  instantly  and  ruth- 
lessly quenched  any  impulse  of  progress  that  might  show  itself 
in  a  particular  individual,  the  indisputable  answer  might  seem 
to  be  that  the  tendency  had  been  baneful.  If  w^e  look  again  to 
the  earlier  ages  of  Christendom,  when  Eome  was  ascendant  and 
its  persecuting  fires  were  in  full  blaze,  and  reflect  that  any 
deviation  from  the  routine  of  the  established  belief,  were  it  ever 
so  good,  was  zealously  extinguished  as  a  pernicious  thing, — the 
logical  theory  of  the  Eoman  Church  being  that  new  doctrine 
should  be  stamped  out  as  a  dangerous  centre  of  infection, — we 
may  imagine  in  a  lame  fashion  how  many  excellent  impulses  to 
new  developments  of  thought  were  extinguished  as  soon  as  they 
showed  themselves. 

Furthermore,  the  celibacy  of  the  priesthood  and  the  numerous 
monasteries  that  were  thickly  scattered  over  the  country  with- 
drew from  freedom  of  thought,  from  the  true  service  of  man- 
kind, and  from  a  legitimate  share  in  the  propagation  of  the 
race,  many  of  the  best  men  and  women  of  the  age;  and  the 
rigid  system  of  a  uniform  and  changeless  belief  which  was 
forced  and  fixed  upon  the  minds  of  men,  barring  all  inquiries 


IV.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      137 

into  the  phenomena  of  nature,  could  not  fail  to  prevent  intel- 
lectual development.  Poetry,  painting,  sculpture,  and  architec- 
ture were  the  channels  through  which  men  of  genius  found 
compensating  outlets  for  the  productive  energies  of  their  nature. 
But  notwithstanding  that  in  their  gxeat  works  mankind  happily 
gained  some  compensation,  the  sceptical  inquirer  may  ask 
whether  the  art  of  a  great  painter  might  not  have  been  put  to 
better  purposes  of  human  elevation  than  to  paint  the  same 
saints  over  and  over  again  ;  and  may  hold  that  a. few  extraordi- 
nary developments  along  the  paths  that  were  left  open  were  not 
an  adequate  set-off  for  the  vast  amount  of  intellect  which  was 
systematically  repressed  by  the  prohibitions  of  authority.  Full 
freedom  for  the  entire  race  to  search,  and  know,  and  work  in 
whatever  du^ection  inclination  may  urge  or  occasion  invite 
would  seem  to  be  now  the  most  certain  foundation  of  human 
progress. 

Eut  it  is  certainly  not  to  be  denied  that  a  belief  in  a  super- 
natural intervention  in  human  affairs  might  be  useful  at  one 
stage  of  human  evolution,  and  indeed  essential  to  social  progress, 
just  as  it  is  essential  to  a  child's  welfare  to  believe  in  and  respect 
its  own  parents,  who  may  nevertheless  be  actually  unworthy  of 
respect,  and  yet  may  be  mischievous  at  a  later  stage  when  it 
has  done  its  work  and  undergoes  decay,  the  intellect  having 
outgrown  it ;  the  more  so  when  it  has  been  corrupted  by  the 
interests  of  priestcraft  and  used  to  promote  the  ends  of  organized 
imposture.  The  only  present  concern  with  the  belief  is  to  know 
whether  its  influence  upon  the  human  mind  is  good  or  ill  now ; 
whether  it  helps  or  hinders  intellectual  and  moral  progress.  How 
can  it  help  if  it  be  not  true  and  be  known  to  be  not  true  ?  To 
affirm  that  the  course  of  nature  may  be  capriciously  interfered 
with  at  any  moment  by  a  power  which  is  outside  nature,  and  that 
the  observed  sequence  of  events  is  but  a  sequence  at  will,  would 
be,  were  it  more  than  lip-doctrine,  to  take  from  man  the  most 
urgent  motive  to  study  patiently  the  laws  which  are  at  work,  in 
order  that  he  may  bring  his  life  into  conformity  with  them,  and 
to  weaken  much  or  to  destroy  altogether  the  responsibility  which 
he  should  feel  to  make  nature  better  through  his  means,  which  he 
will  do  best  by  making  the  best  of  himself.    It  is  the  plain  duty. 


138  PATHOLOGY  OF  MIND.  [chap. 

and  should  be  tlie  steadfast  aim  of  man,  to  carry  on  in  his  future 
evolution  the  evolution  which  has  gone  on  in  the  past ;  and  this 
he  can  do  only  by  recognition  of  the  uniformity  of  nature. 
Prayers  and  sacrifices  to  fetishes,  material  or  spiritual,  will  not 
help,  for  neither  pra3^er  nor  sacrifice  will  obviate  the  consequences 
of  want  of  foresight  or  want  of  self-discipline,  nor  will  reliance 
on  supernatural  aid  make  amends  for  lack  of  intelligent  will. 
Herein  lies  the  imputable  mischief  of  prayer,  that  it  is  an  imbe- 
cility of  will ;  and  when  it  acts,  as  it  commonly  does  act,  by 
strengthening  will  in  a  reflex  way  to  accomplish  what  is  prayed 
for,  that  is  to  say,  through  the  energy  imparted  to  will  by  the  belief 
that  the  prayer  will  be  specially  answxred  if  it  be  well  it  should 
be  so  answered,  the  sceptic  might  question  how  far  it  is  a  benefit 
to  get  such  effects  by  an  illusion — in  a  way  which  is  like  what 
children  "  make  believe  "  ?  Whoever  solicits  by  sacrifice  or 
prayer  a  happy  issue  of  some  venture,  if  he  gets  his  wish,  gets 
it  by  the  ordinary  operation  of  natural  law  ;  the  god  whom  he 
addresses  may  be  deaf,  asleep,  on  a  journey,  it  matters  not  in 
the  least  to  the  result.  !N"or  is  there  any  more  evidence  that  the 
affairs  of  the  spiritual  world  are  not  equally  matters  of  law  and 
order ;  he  who  prays  for  the  creation  of  a  clean  heart  and  for  the 
renewal  of  a  right  spirit  within  him,  if  he  gets  at  last  what  he 
prays  for,  gets  it  not  as  a  miraculous  gift  from  on  high,  but 
through  the  ordinary  laws  of  moral  growth  and  development,  in 
consequence  of  painstaking  watchfulness  over  himself  and  the 
continual  exercise  of  good  resolves.  Were  he  to  fall  down  upon 
his  knees  in  the  same  way  once  or  twice  a  day  without  praying, 
and  thereupon  to  calmly  review  his  past  conduct  and  to  make 
firm  resolutions  to  do  w^ell  for  the  future  in  that  wdierein  he  had 
done  ill  before,  the  result  would  be  the  same.  Nor  could  it  fail 
to  be  better  for  the  strength  and  wholeness  of  human  character 
in  the  end  that  there  should  be  entire  sincerity  in  this  matter. 

Whatever  then  may  have  been  its  use  in  times  past,  what  the 
free  inquirer  has  to  consider  now  is,  whether  a  belief  in  a  fetish 
does  not  mark  a  certain  perversion  or  defect  of  intellectual  deve- 
lopment, and  prayer  or  sacrifice  founded  upon  it  a  certain  per- 
version or  defect  of  will ;  whether  the  fostering  of  it  does  not 
produce  insincerity  or  mar  unity  of  character ;  and  whether,  as 


IT.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       139 

tlie  human  mind  rises  to  a  higher  evolution,  growing  in  insight 
by  more  exact  knowledge  of,  and  in  power  by  corresponding 
adjustment  to,  those  all-pervading  laws  of  order  and  harmony 
through  which  alone  the  supernatural  is  manifest,  the  invisible 
made  visible,  a  belief  which  is  the  prohibition  of  intelligent 
inquiry  and  fatal  to  an  independent  human  bearing  will  not 
help  but  hinder  intellectual  development,  will  not  strengthen  but 
weaken  moral  character.  By  holding  notions  which  are  not 
founded  on  reason  and  cannot  be  reasoned  about,  inasmuch  as 
they  are  assumed  to  transcend  or  may  actually  contradict  reason, 
as  a  part  of  tlie  common  stock  of  its  belief,  the  mind  goes 
counter  to  the  very  principles  of  its  intellectual  being,  under- 
mines its  own  foundations,  proceeds  with,  a  fundamental  incon- 
sistency declaring  itself  in  every  phase  of  its  growth.  What 
wonder  that  with  the  way  so  prepared  and  made  ready  it  accepts 
with  ease,  when  illness  comes,  extravagant  delusions  that  are 
utterly  contrary  to  reason  ! 

But  there  is  another  side  to  the  question  which  it  would  not 
be  right  for  the  free  inquirer  to  leave  out  of  sight.  It  will  be 
said  that  the  behef  in  an  ever-present  help  in  time  of  need  is 
a  priceless  stay  and  comfort  in  all  the  sorrows,  needs,  afflictions 
and  other  adversities  of  life,  and  that  it  sustains  in  the  hour  of 
trial  many  a  sore-stricken  and  heavy-laden  soul  which,  but  for  it, 
would  give  w^ay  and  strive  no  more.  Certainly  there  are  few  ills 
that  have  not  some  compensating  element  of  good,  and  it  were 
strange  indeed  if  a  creed  which  has  plainly  been  a  necessary 
phase  of  thought  in  the  progress  of  mankind  had  been  all  mis- 
chief. Here  again,  however,  comes  the  solemn  question  for  men, 
wdiether  it  can  be  w^ell  for  mankind  now  and  in  the  long  run  to 
have  the  help  of  so  consoling  a  belief  if  it  be  not  true  ?  If  it 
be  confessed  practically,  as  it  is  by  the  daily  course  of  every 
man's  life,  that  no  miraculous  intervention  ever  disturbs  the 
serene  and  stern  uniformity  of  natural  law,  that  no  helping 
hand  from  on  high  is  ever  held  out  specially  to  raise  up  them 
that  have  fallen,  is  not  the  harbouring  of  a  belief  in  supernatural 
aid  likely  to  produce  weakness  by  blunting  the  sense  of  respon- 
sibility which  a  man  has  to  be  strong  with  his  own  strength, 
and  the   profession  of  it  liable  to  become  an  insincerity  or  a 


140  PATHOLOGY  OF  MIND.  [chap. 

hypocrisy  injurious  to  character  ?  It  may  be  a  sad  thing  to 
strike  away  that  crutch  which  alone  seems  to  support  the  feeble- 
ness of  humanity,  but  it  is  plain  that  for  man  to  lean  habitually 
and  heavily  on  a  crutch  is  not  the  way  to  learn  to  walk  firmly ; 
he  will  do  that  best  by  risking  many  falls  and  by  making  more 
skilful  trials  after  each  fall ;  and  in  like  manner  he  who  has  to 
learn  and  to  do  in  a  world  of  natural  law  will  find  his  true 
good  in  getting  strength  through  suffering,  skill  through  trial, 
victory  through  obedience,  and  not  in  reliance  on  supernatural 
interpositions  which  have  hitherto  occurred  for  the  most  part 
where  there  was  no  need  for  their  occurrence,  the  work  being 
done  without  them,  and  have  failed  to  occur  where  they  were 
most  wanted — where  their  help  would  have  been  not  superfluous, 
but  serviceable.  It  is  easy  to  perceive  that  the  savage  is  no  better, 
but  worse,  for  the  prayers  and  sacrifices  which  he  makes  to  his 
fetish ;  and  when  the  reason  why  he  is  not  better  but  worse  for 
such  ignorant  reliance  is  sincerely  considered,  it  will  be  seen 
that  it  applies  wdth  equal  truth  to  any  one  who  puts  faith  in 
any  sort  of  fetish,  it  matters  not  whether  spiritual  or  material. 
That  a  supernatural  power  will  interpose  to  save  a  man's  soul 
alive  who  is  not  doing  his  own  best  to  save  it  for  himself  is 
as  mischievous  a  superstition,  quoad  the  soul's  welfare,  as  the 
savage's  superstition  that  his  fetish  will  preserve  his  body  from 
disease  when  he  takes  no  pains  to  keep  it  in  health  himself  is 
hurtful  to  his  bodily  welfare  :  mental  hygiene  is  impossible  in 
the  one  case  as  bodily  hygiene  is  in  the  other. 

ISTo  doubt  it  may  be  said  that  it  would  be  impossible  to 
cultivate  and  satisfy  the  emotional  element  in  human  nature 
and  to  kindle  moral  enthusiasm  for  the  arduous  toil  of  virtue 
without  a  personal  object  of  love  and  reverence ;  but  it  is  an 
assertion  which  may  plausibly  be  disputed.  Buddha  had  no  per- 
sonal God,  yet  he  was  filled  with  a  deep  and  calm  emotion  Avhich, 
diffusing  itself  through  every  fibre  of  his  being,  inspired  a  life 
of  unparalleled  self-renunciation  and  virtue.  Spinoza  had  no 
personal  God,  being  deemed  an  atheist  by  most  persons,  but  he 
was  unequalled  in  the  simplicity  and  virtue  of  his  humble  life, 
in  his  sincere  love  of  truth,  and  in  his  earnest  devotion  to  it. 
An  assembly  of  freethinkers  and  atheists  will  be  sure  to  applaud 


IV.]      THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       Ml 

enthusiastically  all  expressions  of  liiiman  sympathies,  moral 
sentiments,  and  virtuous  reflections.  So  long  as  man  has 
organic  viscera  he  will  have  emotion  enough,  whatever  his 
beliefs  or  disbeliefs  may  be :  there  need  be  no  fear  that  he 
will  lose  his  emotional  nature  and  become  a  hard  intellectual 
machine  when  he  no  longer  puts  up  prayers  or  offers  sacrifices 
to  a  personal  God  of  like  nature  and  passions  with  himself.  If 
he  apply  himself  systematically  to  that  reverential  study  of 
nature  which  it  is  the  aim  of  science  to  pursue ;  to  that  close 
observation  of  and  sympathy  with  her  multitudinous  and  ever- 
changing  moods  which  artist  and  poet  cultivate ;  if  he  cherish 
that  living  interest  in  human  sufferings,  and  aspirations,  and 
doings  of  which  every  being  has  more  or  less,  but  which  rises 
in  some  men  to  a  lofty  height  of  moral  enthusiasm ;  if  he  culti- 
vate that  sense  of  oneness  with  all  nature  which  philosophy 
opens,  and  to  which  poetry  gives  its  sublimest  expression — he 
will  have  room  enough  for  all  the  emotion  which  he  can  profit- 
ably feel  and  express.  When  I  consider  this  matter  it  always 
appears  to  me  that  Shakespeare  was  not  wanting  in  depth  of 
feeling  or  in  profitable  application  of  it,  and  I  cannot  sympathize 
therefore  with  the  apprehension  that  human  nature  will  be  robbed 
of  its  emotion  so  long  as  it  has  the  whole  of  nature,  physical 
and  human,  to  spend  it  upon. 

It  is  purely  a  gratuitous  and  unfounded  calumny  to  impute  that 
man  who  has  risen  to  the  height  of  his  present  moral  stature  by 
feeling  with  his  kind  and  working  for  it,  will  cease  to  feel  with 
it  and  to  work  for  it  when  he  ceases  to  pray  to  a  personal  God 
who  has  created  countless  multitudes  of  his  kind  to  foredoomed 
torture  through  all  eternity  for  sin  of  which  they  are  innocent ! 
If  a  crowd  is  assembled  to  see  a  brave  man  fling  himself  into 
the  raging  sea  and  battle  with  its  wild  waves  in  order  to  save 
human  life,  or  do  any  other  feat  of  danger  and  skill — be  it  only 
to  climb  a  greasy  maypole — we  observe  how  excited  and  sym- 
pathetic it  becomes  ;  and  shall  we  suppose  that  the  long  toil  of 
humanity  along  that  most  steep  and  arduous  moral  path  which 
leads  to  its  higher  evolution — the  failures  of  those  who  fail  and 
the  successes  of  those  who  succeed — will  quicken  no  feeling, 
kindle  no  enthusiasm  ?      It  is  absurd  to  think  that  mankind 


142  PATHOLOGY  OF  MIND.  [chap. 

will  cease  to  feel  emotion,  even  though  it  should  say  in  its  heart 
that  there  is  no  personal  God;  it  cannot  help  firing  morality 
with  emotion  ;  and  it  may  be  that  a  healthier  feeling  will  be 
quickened  and  a  sounder  emotion  stirred  when  it  is  no  longer 
infected  by  the  taint  of  superstition.  If  it  come  to  pass  that 
man  is  robbed  of  that  narrow  and  intensely  personal  feeling 
which  is  poured  out  in  apjjrehensive  w^ails  about  the  salvation 
of  his  own  soul,  or  in  emotional  shrieks  by  writers  of  the 
spasmodic  and  fleshly  school  of  poetry,  or  in  morbidly  subtile 
analysis  of  overstrained  feelings  of  any  sort,  there  will  be  no 
harm  done;  for  it  is  a  sort  of  emotion  that  is  as  unwholesome 
as  a  hysterical  ecstasy.  Let  him  attain  instead  to  that  calmer, 
deeper,  wider,  and  healthier  emotion  which  is  subordinated  to 
pure  insight  into  the  harmonies  of  nature  and  to  philosophical 
survey  of  its  serene  order,  and  is  applied  objectively  to  give 
warmth  of  tone  and  colour  to  their  expression  in  words.  The 
creed  of  nature  is  not  shrieking  self-assertion,  but  serene  self- 
surrender  ;  not  man  against  the  universe,  but  man  as  a  part  of 
the  universe  ;  not  individual  life  with  the  single  aim  of  securing 
a  blissful  immortality,  but  iu dividual  life  in  wholesome  subordi- 
nation to  the  general  life. 

In  matter  of  fact  it  may  be  doubted  whether  any  one  ever 
does  feel  the  strong  personal  love  of  a  supernatural  power  which 
he  persuades  himself  that  he  feels ;  whether  it  is  not  a  delusion 
and  a  snare ;  whether,  when  he  imagines  he  has  wrought  himself 
into  the  proper  emotional  mood  of  mind,  he  has  not  really 
wrought  himself  into  an  artificial,  vague,  and  somewhat  morbid 
state  of  feeling,  which  is  by  no  means  so  holy  as  he  believes. 
How  there  can  be  the  definite  relation  of  a  genuine  healthy  feel- 
ing between  a  finite  natural  being  and  an  infinite  supernatural 
being  passes  comprehension  when  the  attempt  is  sincerely  made 
to  realize  what  is  meant.  It  would  be  to  feel  the  unfeelable, 
to  know  the  unknowable,  to  limit  the  illimitable — a  contradic- 
tion in  terms,  a  nonsense. 

Here  I  am  brought  to  take  notice  of  what  appears  to  be 
sometimes  a  great  evil  incident  to  the  ordinary  teachings  of 
religion — namely,  the  extreme  stress  which  is  laid  upon  the 
importance  of  the  individual,  the  consequent  habit  of  looking 


IV.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       U3 

to  the  welfare  of  his  own  soul  as  his  chief  concern,  and  the 
cultivation  of  a  regular  inti'ospection  of  his  feelings  as  a  means. 
All  these  things  are  adapted  to  develop  an  exaggerated  self- feeling. 
The  probings  of  the  heart,  the  gloom  of  repentance,  the  stings  of 
remorse,  the  musings  of  meditation  upon  matters  of  conscience, 
which  are  fostered  as  signs  of  a  keen  and  sensitive  conscience, 
are  often  the  unwholesome  outcome  of  an  exaggerated  self-con- 
sciousness, and  are  more  likely  to  lead  to  madness  than  to  good 
relations  and  sound  work  in  the  world.  One  notices  a  marked 
subjective  phase  of  feeling  in  most  persons  soon  after  the 
development  of  puberty,  shown  in  indefinite  longings,  dreamy 
poetical  moods,  and  all  sorts  of  vague  aspirations  ;  consequently 
it  is  a  period  of  life  when  the  mind  is  in  a  state  favourable  to 
introspection,  when  it  easily  acquires  the  habit,  and  when  the 
habit  runs  quickly  to  excess.  Women  are  naturally  more  prone 
to  religious  worship  than  men,  and  more  apt  to  fall  into  a 
morbidly  subjective  habit,  first,  because  of  the  preponderance 
of  the  affective  life  in  them,  and,  secondly,  because  they  have 
not  the  distracting  and  correcting  and  intellectually  hardening 
influences  of  outside  interests  and  pursuits  which  men  have. 
If  unmarried  women  chance  to  come,  as  by  reason  of  these 
conditions  they  are  apt  to  do,  under  the  ignorant  and  misap- 
plied zeal  of  unwise  priests  who  mistake  for  deep  religious 
feeling  what  is  really  morbid  self-feeling  springing  at  bottom 
from  unsatisfied  instinct  or  other  uterine  action  upon  mind, 
the  mischief  is  greatly  aggravated. 

It  were  well  if  those  who  make  it  their  business  to  guide 
the  consciences  of  mankind  through  the  manifold  changes  and 
chances  of  life  were  to  be  at  the  pains  to  inquire  how  much 
supposed  religious  feeling  may  be  due  to  physiological  causes, 
before  they  sanction  or  enjoin  a  repeated  introspection  of  the 
feelings.  He  whose  every  organ  is  in  perfect  health  knows  not 
that  he  has  a  body,  and  only  becomes  conscious  that  he  has 
organs  when  something  wrong  is  going  on;  in  like  manner 
a  healthy  mind  in  the  sound  exercise  of  its  functions  is  little 
conscious  that  it  has  feelings,  and  only  gets  very  self-conscious 
when  there  is  something  morbid  in  the  processes  of  its  activity. 
The  ecstatic  trances  of  such  saintly   women  as  Catherine  de 


144  PATHOLOGY  07  MIND.  [cqap. 

Sienne  and  St.  Theresa,  in  which  they  believed  themselves  to 
be  visited  by  their  Saviour  and  to  be  received  as  veritable 
spouses  into  his  bosom,  were,  though  they  knew  it  not,  little 
else  than  vicarious  sexual  orgasm ;  a  condition  of  things  which 
the  intense  contemplation  of  the  naked  male  figure,  carved  or 
sculptured  in  all  its  proportions  on  a  cross,  is  more  fitted  to 
produce  in  young  women  of  susceptible  nervous  temperament 
than  people  are  apt  to  consider.  Every  experienced  physician 
must  have  met  with  instances  of  single  and  childless  women 
who  have  devoted  themselves  with  extraordinary  zeal  to 
habitual  religious  exercises,  and  who,  having  gone  insane  as  a 
culmination  of  their  emotional  fervour,  have  straightway  ex- 
hibited the  saddest  mixture  of  religious  and  erotic  symptoms 
— a  boiling  over  of  lust  in  voice,  face,  gestures,  under  the  pitiful 
degradation  of  disease.  On  such  persons  the  confessional  has 
had  sometimes  a  most  injurious  effect,  more  especially  in  those 
churches  which,  aping  Romanism  in  their  ritual,  have  not  placed 
confession  under  the  stringent  regulations  and  safeguards  with 
which  the  Eoman  Catholic  Church  surrounds  it.  The  fanatical 
religious  sects,  such  as  the  Shakers  and  the  like,  which  spring 
up  from  time  to  time  in  communities  and  disgust  them  by  the 
offensive  way  in  which  they  mingle  love  and  religion,  are 
inspired  in  great  measure  by  sexual  feeling :  on  the  one  hand, 
there  is  probably  the  cunning  of  a  hypocritical  knave  or  the 
self-deceiving  duplicity  of  a  half-insane  one,  using  the  weak- 
nesses of  weak  women  to  minister  to  his  vanity  or  to  his  lust 
under  a  religious  guise ;  on  the  other  hand,  there  is  an  exag- 
gerated self-feeling,  rooted  often  in  sexual  passion,  which  is 
unwittingly  fostered  under  the  cloak  of  religious  emotion,  and 
which  is  apt  to  conduct  to  madness  or  to  sin.  In  such  case  the 
holy  kiss  of  love  owes  its  w^armth  to  the  sexual  impulse  which 
inspires  it  consciously  or  unconsciously,  and  the  mystical 
reli<nous  union  of  the  sexes  is  fitted  to  issue  in  a  less  spiritual 
union. 

Without  doubt  an  excessive  development  of  the  emotional  life 
in  any  other  direction  would  be  equally  pernicious.  All  that  the 
unwise  religious  teacher  can  be  blamed  for  is  his  disposition  to 
foster  the  egoistic  development  of  emotion,  without  considering 


IV.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       145 

its  real  origin,  by  the  overwhelming  importance  which  he 
teaches  the  individual  to  attach  to  himself  and  liis  destiny. 
Instead  of  urging  him  to  lessen  the  gap  between  himself  and 
nature  until  he  loses  self  in  a  sympathetic  oneness  with  nature, 
he  stimulates  him  to  widen  it  more  and  more  until  he  rises  to 
the  insane  conceit  of  himself  as  something  entirely  distinct  from 
nature — an  unrelated,  spiritual  essence,  for  whose  benefit  the 
universe  and  all  that  therein  is  has  been  specially  created. 
Assuredly  were  not  man  now,  as  he  always  has  been,  instinc- 
tively wiser  than  his  creeds,  were  he  not  moved  by  a  deeper 
impulse  than  consciousnesss  can  give  account  of,  he  would 
make  no  progress  in  evolution. 

On  comparing  the  best  pagan  modes  of  thought  with  Christian 
modes  of  thought  a  doubt  might  be  raised  whether  the  latter 
have  not  sometimes  been  less  favourable  to  a  calm  and  stable 
mental  development.  Contrast,  for  example,  the  widely  different 
views  and  feelings  with  which  death  was  regarded.  To  the  pagan 
it  was  the  twin  brother  of  sleep,  the  youth  with  inverted  torch, 
the  natural  rest  at  the  end  of  the  long  day's  task  of  life  which 
the  wise  man  would  not  fear,  but  welcome ;  to  the  Christian  it 
was  presented  in  all  the  horrors  imaginable,  as  the  consequence 
and  the  punishment  of  sin,  the  king  of  terrors,  the  last  enemy, 
the  opportunity  of  exulting  fiends  to  clutch  their  shrieking  prey, 
the  possible  gate  to  unspeakable  torments  through  all  eternity.  I 
find  it  impossible  to  conceive  the  countless  hours  of  torment, 
the  unspeakable  agony  of  mind,  which  this  doctrine  must  have 
caused  since  it  was  first  propagated  :  what  quivering  reflections, 
what  keen  anguish  of  remorse,  what  agonizing  apprehensions, 
what  torturing  self- examinations,  what  appalling  fears  have  been 
occasioned  in  anxious  and  tender  consciences  by  a  doctrine 
which,  far  outdoing  in  barbarity  the  most  barbarous  superstition 
that  savage  ever  conceived,  is  still  preached  from  a  thousand 
pulpits  in  every  civilised  country,  notwithstanding  that  there 
is  not  a  person  of  sincere  understanding  who  rigorously  analyzes 
his  thoughts  and  sternly  realizes  what  the  doctrine  means  can 
say  from  the  bottom  of  his  heart  that  he  believes  it.  Hope  and 
fear,  which  are  based  upon  the  self-conservative  instinct  in  its 
relation  to  the  future,  are  two  most  powerful  passions  in  human 


146  PATHOLOGY  OF  MIND.  [chap. 

nature,  and  it  is  upon  them  that  religion  has  fastened  and  works 
with  all  the  powerful  machinery  of  its  system ;  its  aim  and 
effect  heing  to  produce  not  wholesome  subordination  of  feeling 
to  reason,  but  an  unwholesome  predominance  of  emotion. 
Happily  human  conduct  has  again  shown  itself  wiser  than 
human  creed :  men  concern  themselves  more  about  the  most 
trivial  events  of  the  actual  to-morrow  than  about  the  most 
momentous  issues  of  the  possible  life  to  come ;  motives  lose  in 
force  in  proportion  as  they  recede  in  distance ;  and  the  fear  of 
punishment  and  the  hope  of  reward  after  death,  which  always 
seem  to  be  possibilities  afar  off,  do  not  work  with  any  force 
upon  the  hearts  of  the  vast  majority  of  those  who  profess  to  be 
affected  by  them.  Without  doubt  it  does  happen  from  time  to  time 
that  a  person  of  anxious  and  foreboding  temperament,  brooding 
over  his  sins,  falls  into  a  sort  of  spasmodic  horror  of  the  dread 
eventuality  of  eternal  damnation,  and  becomes  melancholy-mad, 
believing  himself  to  have  sinned  beyond  possibility  of  forgive- 
ness and  to  be  eternally  lost ;  but  in  such  case  the  religious 
delusion  is  oftentimes  no  more  than  the  convenient  and  sufti- 
cient  shape  which  the  mental  depression  takes  in  order  to  get 
adequate  expression,  and  it  is  not  unlikely  that  the  person 
would  have  equally  gone  insane  and  have  had  some  other 
gloomy  delusfon  if  he  had  not  known  religious  doctrine.  A 
more  deep  and  widespread  mischief  attributable  to  the  doctrine 
of  future  rewards  and  punishments,  is  the  deadening  of  the 
feelings  and  the  blinding  of  the  intelligence  of  men  to  the 
certain  laws  by  which  their  sins,  errors,  and  ill  doings  of 
all  sorts  are  avenged  upon  themselves  or  upon  others  in  this 
world,  and  to  the  stern  responsibilities  to  observe  and  obey 
which  the  reign  of  natural  laws  imposes  upon  them. 

One  consideration  more,  and  I  pass  from  this  subject.  Look- 
ing to  the  exalted  moral  code  which  is  inculcated  as  the  essen- 
tial rule  of  Christian  practice,  some  attempt  should  be  made  to 
weigh  the  actual  effect  on  character  of  the  solemn  profession  of 
principles  and  precepts  which  appear  to  be  too  exalted  to  be 
reconciled  with  the  exigencies  of  practical  life.  The  Christian 
religion  is  a  religion  of  passivity  rather  than  of  activity;  it 
teaches  mankind  how  to  suffer  better  than  how  to  do  in  the 


IV.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      147 

world ;  and  if  its  principles  were  faithfully  carried  out  in  prac- 
tice they  could  not  fail  in  the  end  to  leave  the  good  man  at  the 
mercy  of  the  knave.     It  was  a  gospel  which  could  be  preached 
with  more  consistency  and  sincerity  to  a  world  which  was  thought 
to  be  close  upon  its  end,  when  nothmg  better  could  be  done  than 
to  prepare  for  it,  than  it  can  be  to  a  world  which  has  gone  on, 
and  goes  on,  as  if  it  were  never  coming  to  an  end.  In  commerce, 
on  the  exchange,  in  political  life,  in  all  the  departments  of  prac- 
tical activity,  a  man  must  have  another  creed  and  another  prac- 
tice.  On  the  one  hand,  then,  he  fulfils,  as  essential  to  his  present 
well-being,  the  law  of  natural  selection,  by  which  tlie  strong 
takes  advantage  of  his  strength  and  the  weak  is  made  to  pay 
the  penalty  of  his  weakness ;  on  the  other  hand  he  professes,  as 
essential  to  his  eternal  well-being,  the  altruistic  doctrine  that  he 
should  not  lay  up  for  himself  treasure  on  earth,  that  he  should 
prefer  his  brother  in  all  things  to  himself,  that  when  he  is  smit- 
ten on  one  cheek  he  should  meekly  turn  the  other  also  to  the 
smiter.   But  it  cannot  be  conducive  to  the  strength  and  harmony 
of  intellectual  and  moral  character  that  there  should  be  a  funda- 
mental contradiction  between  faith  and  works  whereby  life  is 
made  a  shifting  compromise,  or  a  systematic  inconsistency,  or 
sometimes  an  organized  hypocrisy;  and  one  cannot  help  thinkincy 
that  it  would  be  well  that,  instead  of  a  rule  of  life  consistino^ 
of  natural  selection  irregularly  and  occasionally  tempered  by 
Christianity,  there  should  be  established  a  fundamental  harmonv 
between  religion  and  practice.     If  accepted  doctrines  will  not 
grow  to  new  requirements  they  must  be  changed,  since  no  doc- 
trine can  claim  to  bind  rigidly  the  belief  of  mankind  for  all  time, 
or  can  so  bind  it  without  putting  a  stop  to  mental  development. 
These  general  reflections  upon  the  working  of  religion  upon 
human  character  will  indicate  how  little  use  it  is  to  discuss,  as 
is  sometimes  done,  whether  insanity  occurs  more  often  in  one 
sect  of  Christians  than  in  another.    There  are  no  statistics  upon 
which  we  can  venture  to  place  the  least  reliance  to  decide  the 
question.    Any  sect  which  fosters  habitual  emotional  excitement, 
or  lends  its   authority  to  extraordinary  displays    thereof,   will 
favour  the  production  of  instability  of  mind  and  so  predispose 
to  the  easy  overthrow  of  its   balance.     "When  the  religion  is 


148  PATHOLOGY  OF  MIND.  [chap. 

mainly  a  social  observance  which  it  beseems  a  person  of  respecta- 
bility, willing  to  stand  well  with  his  neighbours,  to  conform  to, 
it  will  in  this  country  most  likely  be  the  religion  of  the  Church 
of  England,  which  suits  well  success  in  life  and  a  respectable 
social  position  ;  not  exacting  any  show  of  zeal  from  nor  im- 
posing any  galling  yoke  upon  its  members,  for  the  most  part 
eschewing  anything  that  is  extreme,  claiming  only  from  its 
bishops  that  they  should  evince  no  tendency  to  deviate  into 
originality  or  zeal,  and,  as  an  established  religion  in  alliance  with 
social  institutions  and  the  governing  classes,  aiming  to  preserve 
the  established  state  of  things.  But  it  must  honestly  be  ad- 
mitted that  this  Church  does  not  reach  those  who  are  in  poverty 
and  affliction,  whose  daily  lives  are  daily  hard  struggles  to  live, 
who  most  need  a  gospel  or  glad  message  to  solace  and  sustain 
them.  These,  if  they  profess  any  religion  at  all,  belong  mostly 
to  one  or  other  of  the  two  religious  divisions  into  which  the  two 
extreme  and  opposite  parties  in  the  English  Church  insensibly 
pass — to  Eoman  Catholicism  at  the  one  end,  or  to  one  of  the 
sects  of  Dissenters  at  the  other  end  ;  for  the  Church  of  England 
stands  as  a  Church  of  passage  between  Eoman  Catholicism  and 
Dissent,  as  all  forms  of  Protestantism  are  logically  creeds  of 
passage  between  Eoman  Catholicism  and  a  complete  emancipa- 
tion from  belief  in  the  supernatural.  In  weighing,  then,  the 
effect  of  religion  as  predisposing  or  not  to  insanity,  we  have 
practically  to  do  wath  Eoman  Catholicism,  actual  or  abortive, 
or  with  Dissent  in  one  or  other  of  its  forms. 

There  is  no  reason  to  believe  that  the  Eoman  Catholic  religion 
has  any  special  tendency  to  produce  insanity  among  those  who 
are  within  its  pale.  It  does  not  encourage  throes  of  emotional 
spasm,  its  infallibility  is  a  fast  anchor  for  distressed  souls  to 
hold  by,  and  the  morbidly  tender  conscience  is  eased  sometimes 
of  the  burden  which  weighs  upon  it  by  the  clear  sense,  calm 
judgment,  and  trained  sympathy  of  an  experienced  priest  who 
dissipates  exaggerated  apprehensions  and  administers  fitting 
spiritual  remedies.^  Moreover,  the  assured  belief  that  sins  can 
be  remitted  through  penances,  and  that  the  priest  is  divinely 

1  That  is  one  side  of  the  matter  :  an  injudicious  or  dishonest  priest, 
encouraging  morbid  outpourings,  may  do  infinite  mischief. 


IV.]       THE  CAUSATION  AND  PEEVENTION  OF  INSANITY.      149 

empowered  to  grant  absolution  from  them,  will  not  fail  to  have 
a  like  comforting  effect.  A  priesthood  standing  as  mediator 
between  the  trembling  slave  and  his  offended  master,  and  in- 
vested with  a  delegated  authority  to  mitigate  terrors,  may  not 
be  an  altogether  hurtful  institution  w^here  a  belief  in  the  capri- 
cious intervention  of  a  supernatural  power  in  human  affairs 
prevails  :  it  is  a  compensatiug  artificial  support  for  the  intellec- 
tual feebleness  and  moral  impotence  produced  by  a  debilitating 
creed,  the  necessary  complement  of  it.  ISTo  unbiased  mind  can 
doubt  that  the  unquestioning  faith  demanded  by  priests  and 
accorded  by  disciples,  and  the  pretence  that  all  truth  has  been 
delivered  into  the  keeping  of  the  Church  from  the  beginning, 
are  inimical  to  the  true  interests  of  mankind,  a  hindrance  to  its 
progress,  and  a  standing  menace  to  its  dignity ;  not  a  whit  less 
so  than  the  unquestioning  credence  and  trembling  submission 
which  the  savage  yields  to  the  claims  of  his  fetish.  Savage  and 
Catholic  may  boast  of  being  untroubled  by  doubt,  but  they  gain 
their  peace  of  mind  at  the  cost  of  an  arrest  of  the  development 
of  the  understanding. 

The  philosophical  observer  who  has  given  close  attention  to 
the  extremer  forms  of  Protestantism  in  their  relation  to  charac- 
ter, such  as  are  known  as  Evangelicalism,  must  have  noticed 
how  often  they  go  along  with  an  extraordinary  insincerity  or 
actual  duplicity  of  character.  I  mean  not  to  insinuate  that  the 
tendency  of  an  evangelical  faith  is  to  engender  duplicity  of 
character;  the  reason  of  the  connexion  probably  is  that  per- 
sons of  that  character  are  attracted  naturally  to  a  form  of  creed 
which,  making  large  use  of  the  sort  of  emotion  that  springs 
from  self-feeling,  yields  them  the  gratification  of  a  suitable 
emotional  outlet,  and  by  the  habitual  employment  of  a  con- 
ventional religious  phraseology  keeps  out  of  sight,  or  at  any 
rate  veils  thickly,  the  gross  variance  between  high  profession 
and  low  practice  wdiich  the  use  of  a  common  language  could 
not  well  fail  to  bring  clearly  home.  They  use  conventional 
language  without  ever  sincerely  analyzing  its  meaning,  because 
they  find  in  it  fit  expression  for  certain  narrow  feelings  that 
have  been  associated  with  it,  and  are  more  comforted  by  the 
phraseology  than  if  they  really  understood  it ;  it  has  become  a 


150  PATHOLOGY  OF  MIND.  [chap. 

sliibboletli  to  them,  tlie  sign  of  special  grace,  like  that  blessed 
word  Mesopotamia,  the  so-uiid  of  which  yielded  so  much  comfort 
to  the  old  woman  of  the  village.  They  are  not  the  conscious 
hypocrites  which  they  seem;  they  are  inconsistent  without 
really  feeling  their  inconsistency ;  the  two  diverse  developments 
of  their  nature  do  not  interwork,  and  they  go  on  with  an  in- 
coherence of  character  which  they  never  realise,  not  otherwise 
than  as  an  insane  person  will  go  on  quietly  in  a  daily  routine 
of  life  that  is  utterly  inconsistent  with  a  fixed  delusion  which 
he  has  all  the  while  concerning  himself.  A  nature  of  this  sort 
is  well  fitted  to  breed  insanity ;  my  experience,  indeed,  has  led 
me  to  look  upon  it  as  a  singularly  effective  cause  of  degeneracy 
in  the  next  generation. 

Admitting  that  a  person's  religious  profession  is  very  much 
the  expression  of  his  character  and  of  its  mode  of  development, 
and  no  more  therefore  the  real  cause  of  his  insanity,  if  he  falls 
insane,  than  religion  is  the  real  cause  of  the  insanity  of  one 
whose  overweening   self-conceit  has  culminated   in  a  delusion 
that  he  is  an  inspired  prophet — the  fundamental  tendency  in 
each  case  having  fallen  upon  conditions  favourable  to  its  morbid 
growth  in  the  religious  views  and  practices  adopted — it  might 
still  be  argued  that  any  body  of  men  which  separates  itself 
from  the  rest  of  the  world   as   a  specially  favoured   religious 
sect,  hugging  itself  in  the  belief  of  the  exclusive  possession  of 
vital  spiritual  trutlis  which  the  rest  of  mankind  fail  to  apprehend, 
and   living  apart  as  a  sort  of  chosen  people,   adopts  a  course 
which  is  injurious  to  character  and  errs  from  the  true  path  of 
healthy  progress.     The  pride  of  opinion,  the  conceit  of  supe- 
riority, the  narrow  and  complacent  spirit  of  the  sect  react  upon 
the  characters  of  the  individuals  who  compose  it,  and,  isolating 
them  from  wholesome  relations  with  their  kind,  instigate  these 
sectaries  to  a  special  and  unsound  mode  of  thought  concerning 
the  world  and  their  position  in  it.     Moreover,  their  conduct  is 
apt  to  suffer:  there  is  no  small  danger  of  their  devotion  being 
not  to  truth,  but   to  sect   in  the  first   instance,  and   of  their 
acquiring  an  esoteric  and  an  exoteric  conscience  ;  the  former  for 
use  among  their  co-religionists,  and  the  latter,  of  quite  another 
kind,  for  use  among  the  rest  of  mankind.     These  sectarian  divi- 


IV.]       THE  CAUSATION  AND  PKEVENTION  OF  INSANITY.       151 

sions  in  the  intellectual  and  moral  sphere  are  as  injurious  to 
true  religious  progress  as  the  divisions  of  a  nation  into  tribes 
suspicious  of  or  hostile  to  one  another  would  be  to  the  true 
interests  of  the  nation :  we  may  compare  them  to  the  divisions 
into  scattered  tribes  which  prevailed  among  mankind  in  the 
early  stages  of  its  progress,  before  it  had  reached  the  height  of 
national  union  and  had  grown  to  the  apprehension  of  the  higher 
moral  relations  which  such  an  union  involves.  AYhat  the 
strength  of  the  religious  bond  is,  how  effectual  to  hold  a  people 
together,  is  well  shown  by  the  example  of  the  Jews,  who, 
having  no  state,  no  country,  no  common  language,  no  bond  of 
unity  except  a  common  religious  belief  kept  alive  by  a  common 
ceremonial,  have  remained  a  distinct  people  until  this  day.  The 
Armenians  furnish  another  but  less  striking  instance  of  the- 
strenoth  of  the  religious  tie. 

Theoretically  religion  should  be  the  bond  of  unity  to  gather 
all  mankind  into  one  brotherhood,  linking  them  in  good- will  and 
good  work  to  one  another ;  whereas  practically  it  has  hitherto 
been  that  which  has  most  divided  men,  and  the  cause  of  more 
hatreds,  more  wars,  more  disorders,  more  persecutions,  more 
bloodshed  than  all  other  causes  put  together.  In  order  to  pre- 
serve peace  and  order,  therefore,  the  state  in  modern  times  has 
been  compelled  to  divorce  itself  practically  from  religion  and  to 
leave  to  each  sect  liberty  to  do  as  it  likes  so  long  as  it  meddles 
not  by  its  tenets  and  its  ceremonials  with  the  interests  of  civil 
government.  Toleration  of  all  religious  doctrines  and  practices, 
so  long  as  they  do  not  touch  the  practical  concerns  of  life,  has 
become  the  necessary  maxim  of  state  policy ;  very  much  as  in  a 
lunatic  asylum,  where  it  is  found  impossible  to  make  the  inmates 
think  in  a  common  way  to  common  ends,  full  liberty  of  delusions  is 
left  to  each  inmate  so  long  as  he  does  not  act  upon  them  in  such 
a  way  as  to  interfere  with  the  order  of  the  establishment.  It  is 
not  a  little  inconsistent  that  the  sects  should  raise  the  outcry 
they  do  against  irreligion  which  are  themselves  the  negation  of 
true  religion.  Then  again,  what  high  treason  against  humanity 
have  their  partizans  perpetrated !  They  have  robbed  it  of  its 
highest  achievement,  the  most  perfect  hfe  of  self-renunciation 
which  has  been  lived  on  earth,  by  trauslatiug  it  from  a  human  to 


152  PATHOLOGY  OF  MIND.  [chap. 

a  divine  category,  and  so  liiive  done  their  best  to  wither  its 
hopes  and  paralyze  its  efforts  to  repeat  that  great  achievement. 

But  I  must  not  continue  reflections  which  would  carry  me  far 
beyond  the  scope  of  this  work  :  the  end  of  the  whole  matter 
for  the  present  is  that  if  the  prime  condition  of  true  religion  be 
to  get  quit  of  the  belief  of  special  supernatural  interventions 
in  human  affairs,  physical  or  moral,  the  maintenance  of  such 
belief  cannot  be  a  strength  but  a  weakness  to  the  mind,  and  so 
far  will  predispose  to  derangement  of  it. 

Education. — Next  in  importance  to  the  inborn  nature  is  the 
acquired  nature  which  a  person  owes  to  his  education  and  train- 
ing :  not  alone  to  the  education  which  is  called  learning,  but  to 
that  development  of  character  which  has  been  evoked  by  the 
conditions  of  life.  Undoubtedly  a  person  may  be  w^ell-educated 
by  experience  who  can  hardly  read  or  write,  as  it  haj^pens 
sometimes  that  a  person  has  a  great  deal  of  learning  and  is 
nevertheless  very  ill-educated.  AYriters  on  insanity  discuss  the 
question  whether  educated  persons  are  more  liable  to  go  mad 
than  uneducated  persons,  agreeing  not  always  in  their  conclu- 
sions ;  and  in  the  reports  of  lunatic  asylums  numerous  statistics 
are  given  to  show  how  many  patients  have  received  a  "  good  " 
education  and  how  many  have  had  little  or  no  education.  The 
statistics  are  of  no  value,  and  the  speculations  founded  on 
them,  how  ingenious  soever,  must  be  vain  until  there  is  some 
agreement  as  to  what  is  meant  by  good  education. 

Many  persons  consider  it  no  true  education  which  does  not 
instil  into  the  mind  of  youth  from  the  earliest  dawn  of  intelli- 
gence the  doctrines  and  the  stories  of  the  Bible  as  most  sacred 
truths,  having  an  authority  which  reason  can  add  nothing  to  if  it 
confirm  them,  nor  take  anything  from,  if  it  contradict  them ;  and 
until  lately  it  was  generally  thought  to  be  a  proper  and  suffi- 
cient education  to  teach  boys  to  understand  the  Greek  and  Latin 
languages  and  some  mathematics,  and  girls  not  even  so  much  as 
that.  If  wdiat  has  been  before  said  concerning  a  belief  in  the 
supernatural  be  true,  and  if  man's  power  of  acquiring  knowledge 
and  weighing  evidence  through  reason  is  not  checked  and  con- 
trolled in  the  most  arbitrary  manner  by  revelation,  it  is  plain 
that  a  great  part  of  the  human  race,  instead  of  being  educated. 


IV.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      153 

has  been  persistently  miseclucated  for  a  long  time  ;  and  if  recent 
reforms  in  the  kind  of  instruction  given  in  schools  be  just,  it  is 
plain  that  past  generations  had  nothing  like  a  proper  education 
in  that  wherein  they  were  not  miseducated.  The  right  questions 
then  for  writers  to  discuss  would  be  not  wdiether  education  has 
increased  or  lessened  the  liability  to  insanity,  but  whether  the 
miseducation  in  vogue  has  enervated  or  vitiated  human  thought 
and  feeling  and  so  predisposed  to  disorder  of  them,  and  whether 
a  better  education  may  not  counteract  the  evil.  For  it  will  be 
admitted  on  all  hands  that  the  best  education  would  be  the 
stronojest  barrier  ac^ainst  mental  derano-ement  which  it  w^ould  be 
possible  to  raise ;  a  pity  it  is  therefore  that  men  are  not  agreed 
as  to  what  is  the  best  system  of  education. 

For  my  part  I  desire  to  think  that  there  is  a  great  deal  of 
undeveloped  mentality  in  the  mass  of  mankind  which  past 
education  has  scarcely  touched,  but  which  an  improved  and  ex- 
tended system  of  education  will  bring  by  degrees  into  activity, 
to  the  great  profit  of  the  race  in  its  future  travail.  The  basis 
of  a  better  system  must  be  a  sincere  recognition  of  the  reign  of 
law  throughout  nature,  mental  as  w^ell  as  physical,  and  of  the 
momentous  responsibility  to  act  in  conformity  with  knowledge. 
No  one  can  doubt  that  the  study  of  tlie  natural  sciences,  by 
which  are  made  known  the  complex  operations  of  laws  in  the 
various  domains  of  nature,  does  furnish  a  valuable  training  of 
the  intellect  by  teaching  how  to  observe  accurately,  to  reason 
soundly  from  facts,  and  to  think  sincerely  ;  truth  in  them  being 
pursued  entirely  for  its  own  sake  without  regard  to  preconceived 
opinion  or  to  the  claims  of  authority,  and  patience  in  inquiry, 
humility  of  attitude,  and  veracity  of  thought  being  essential 
qualities  in  the  true  servant  and  interpreter  of  nature.  ]\Io re- 
over,  new  insights  into  the  secrets  of  nature  lead  to  new  adjust- 
ments on  the  part  of  man  to  his  complex  surroundings  and  to 
corresponding  new  gains  in  power  :  his  best  gains  are  to  the 
best  gain  of  nature,  and  the  best  gains  of  nature  are  his  true 
gain.  If  he  fails  by  searching  to  find  out  a  law  and  so  acts  in 
ignorance  of  it,  or  if,  knovring  it,  he  disobeys  it  recklessly  or 
wilfully,  he  certainly  brings  punishment  upon  himself  or  upon 
oiliers;  he  is  contending  with  an  adversary  who  neither  makes 


154  PATHOLOGY  OF  MIND.  [chap. 

mistakes  nor  overlooks  tliem,  foregoes  no  advantage,  feels  no  pity, 
inexorably  exacts  the  full  forfeit  of  failure,  and  who  is  not  to  be 
bribed  by  offerings  nor  placated  by  prayers  :  he  must  suffer  for 
his  sin,  and,  learning  wisdom  through  suffering,  do  more  wisely 
for  the  future  in  that  wherein  he  erred  in  the  past.  What  moral 
discipline  can  be  better  than  that ;  what  more  suited  to  make 
men  take  earnest  pains  to  do  well  ?  Actual  intercourse  with 
nature  is  the  best  schoolmaster,  teaching,  as  it  does,  the  lessons 
of  experience  which  actually  do  guide  men  in  the  conduct  of 
life;  for  the  maxims  of  worldly  prudence  according  to  which 
they  act  in  their  dealings  with  one  another  and  in  their  worldly 
affairs  are  sincerely  held  and  faithfully  observed ;  being  founded 
upon  experience  of  the  harm  which  ensues  from  disregard  of 
them,  they  have  a  real  and  constant  influence  upon  conduct 
which  the  maxims  of  philosophy  and  even  the  doctrines  of 
religion  have  not.  Were  these  doctrines  based  securely  and 
plainly  upon  the  same  positive  basis  of  experience,  and  were 
they  to  appeal  as  directly  to  the  reason  of  mankind,  it  is  pro- 
bable that  there  would  be  the  same  unwillingness  to  perpetrate 
the  folly  of  disobeying  them. 

It  may  be  alleged,  no  doubt,  that  the  formation  of  character 
implies  much  more  than  a  mere  increase  of  knowledge,  whether 
by  the  inductive  or  other  method,  and  more  than  an  increase 
of  the  intellectual  power  which  increased  knowledge  confers; 
but  the  answer  to  that  objection  is  that  the  knowledge  of  the 
reign  of  law  in  nature  does  guide  our  impulses  to  wiser  and 
therefore  better  action,  that  good  action  promotes  in  time  corre- 
sponding moral  development  of  character  in  the  race,  and  that 
this  moral  effect  is  multiplied  by  the  recognition  of  the  reign  of 
moral  law  in  the  domain  of  human  evolution.^     The  repetition 

1  I  have  not  the  least  intention  to  argue  that  tlie  study  of  the  physical 
sciences  is  a  moral  regenerator  of  the  individual  who  pursues  it,  or  that 
scientific  men  are  any  more  free  than  other  people  from  envy,  jealousy, 
vanity,  and  other  mean  passions.  On  the  contrary,  they  seem  more  prone 
to  them,  probably  because  they  are  few  and  come  into  close  competition. 
Moreover,  I  do  not  fail  to  recognize  the  folly  of  the  scientific  superstition 
entertained  by  some  persons,  that  scientific  study  is  a  particularly  exalted 
labour,  which  is  of  unspeakable  value,  and  should  be  held  in  supreme  re- 
verence apart  from  its  bearing  on  human  welfare.  Science  is  simply 
knowledge,  and  is  neither  more  nor  less  valuable  than  other  knowledge 


IV.]       THE  CAUSATION  AND  PKEVENTION  OF  INSANITY.       155 

of  good  action  generates  the  habit  of  doing  well,  function  de- 
veloping structure,  and  the  habit  of  doing  well  generates  a 
moral  feeling  in  regard  to  such  action,  which  it  becomes  at  last 
a  pain  to  go  against.  Those  who,  following  Comte,  insist  that 
the  impulses  to  action  come  not  from  the  understanding  but 
from  the  feelings,  and  thereupon  go  on  to  affirm  unreservedly 
that  the  understanding  has  nothing  to  do  with  the  springs  of 
human  conduct,  have  stopped  at  a  half-truth  which  Comte 
would  have  repudiated.  "  Man,"  he  said,  "  becomes  more 
sympathetic  in  proportion  as  he  becomes  more  synthetic  and 
more  synergetic  : "  in  other  words,  in  proportion  as  he  constructs 
for  himself  a  truer  and  more  complete  theory  of  his  relations  to 
nature,  physical  and  human  {synthesis) ^  and  acts  more  faithfully 
with  and  for  his  kind  {synergy),  so  will  he  develop  in  his  nature 
a  quicker  and  fuller  human  sympathy  and  have  stronger  moral 
impulses  springing  therefrom.  The  enforcement  of  sanitary 
measures  to  improve  the  dwellings  and  the  condition  of  the 
poor  might  have  been  preached  in  vain  had  not  infectious  fevers 
bred  in  pestilent  quarters  taught  the  lesson  of  a  common 
humanity  by  a  very  effective  sort  of  sympathy  between  man 
and  man — the  contagion  of  disease ;  but  now  that  the  laws  of 
health  are  becoming  known  and  public  efforts  are  being  sys- 
tematically made  to  get  some  observance  of  them,  we  perceive 
that  a  feeling  of  repugnance  to  disease-breeding  conditions,  a 
sort  of  sanitary  conscience,  is  gradually  being  engendered,  out 
of  which  we  may  expect  to  spring  more  urgent  impulses  to  do 
away  with  them. 

This  example  of  what  is  going  on  now  may  serve  to  illustrate 
how  the  moral  sense  of  mankind  was  originally  developed  out 
of  moral  action  ;  for  the  moral  sense  embodies  in  its  nature  and 
displays  in  its  function  the  kind  of  action  through  which  it 
has  in  the  long  course  of  ages  been  ingrafted  as  an  instinct  or 
feeling  in  the  human  heart ;  the  altruistic  action  having  been  first 
entered  upon  in  a  feeble  way  from  a  dim  perception  of  its  ser- 
vice to  the  social  life,  and  continued  because  of  the  unity  and 

that  helps  men  how  to  live.  Moral  progress  must  be  looked  for  particularly 
in  the  pursuit  of  social  and  moral  science,  and  in  the  working  of  general 
scientific  knowledge  upon  the  race  gradually  through  generations. 


156  PATHOLOGY  OF  MIND.  [chap. 

strength  wliicli  it  gave  to  the  community.  In  like  manner  we  may 
observe  in  the  process  of  deterioration  of  character  how  habitual 
action  modifies  feeling  and  desire  :  no  one  ever  becomes  suddenly 
a  monster  of  baseness,  losing  all  sympathy  with  goodness  and 
evincing  a  positive  relish  for  iniquity  in  an  instant,  any  more 
than  he  gets  any  other  acquired  taste  in  an  instant ;  but  by  a 
course  of  wicked  deeds,  the  first  of  which  was  done  perhaps 
against  the  grain  under  some  strong  temptation,  the  next  with 
less  repugnance,  and  the  next  more  easily  still,  such  a  deteriora- 
tion of  nature  is  wrought  by  degrees  in  him  that  the  evil  stirs 
not  a  repugnant  feeling,  but  an  actual  desire  to  do  it.  Good 
impulses  to  act  come  out  of  good  feelings  as  bad  impulses  come 
out  of  bad  feelings,  and  good  feelings  are  slowly  ingrained  in 
human  character,  become  instinct  in  it,  by  a  course  of  wise 
doings.  Should  it  ever  come  to  pass  that  mankind  attains  to  so 
complete  a  knowledge  of  all  the  laws  of  nature  in  its  manifold 
and  complex  operations  as  to  perceive  instantly  the  right  way 
of  obedience  for  wisdom  to  take  in  any  event  and  to  take  it, 
there  will  be  developed  a  conscience  so  calm,  so  strong,  so  all- 
embracing  that  to  sin  against  it  will  be  looked  upon  as  crime 
or  madness :  the  freedom  of  the  will  will  be  the  freedom  of 
madness. 

It  may  be  objected  that  men  obey  the  law  of  gravitation 
every  moment  of  their  lives  without  having  any  moral  feeling 
generated  with  regard  to  it ;  but  the  objection,  when  fairly  con- 
templated, is  not  of  much  weight.  In  the  first  place,  the  law  of 
gravitation  is  a  physical  law,  the  violation  of  which  is  followed 
directly  by  punishment  to  the  individual,  whereas  the  conse- 
quences of  the  violation  of  a  moral  law  necessarily  affect  others 
and  are  usually  remote ;  the  individual  who  breaks  it  injures 
not  only  himself,  but  the  society  of  which  he  is  a  member — 
that  is  the  essence  of  the  transgression  :  he  strains  the  bond  of 
the  social  state.  By  reason  of  the  community  of  kind  in  men 
and  of  the  sympathy  which  there  is  between  them  as  members 
of  a  common  body  who,  though  having  different  offices,  serve 
a  common  end,  and  therefore  suffer  in  common  from  individual 
wrong-doing,  their  sympathies  and  antipathies  are  necessarily 
stirred,  and  feelings  of  approbation  of  what  is  done  right  and 


IV.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       157 

of  disapprobation  of  what  is  done  wrong  accompany  obedience 
to  and  infraction  of  moral  law.  The  difference  between  a 
physical  law  and  a  moral  law  in  this  relation  is  much  like  the 
difference  between  a  mechanical  structure  and  a  living  organism  : 
the  whole  house  may  not  be  much  hurt  by  the  decay  or  injury 
of  one  or  two  of  the  bricks  of  which  it  is  built,  but  the  whole 
body  will  not  fail  to  be  affected  by  the  decay  or  injury  of  one 
or  two  of  the  oroaus  which  constitute  it.  To  violate  the  law 
of  gravitation  is  a  folly ;  to  violate  the  moral  law  is  a  sin,  for  it 
is  an  injury  to  the  social  organism :  the  former  offence  is  a  sin 
against  science,  that  is,  knowledge ;  the  latter  is  a  sin  against 
conscience,  that  is,  that  essential  human  feeling  which  has  been 
sublimed  out  of  the  relations  of  the  communion  of  men  in  the 
social  state.  Of  the  social  communion  of  men  the  moral  sense 
is  the  highest  fragrance,  as  the  religious  conscience  is  the  highest 
fragrance  of  the  communion  of  the  saints. 

When  Christians  assemble  together  in  holy  communion  to 
break  bread  in  memory  of  the  life  and  sufferings  of  their 
Saviour,  they  solemnly  renew  and  attest  their  conviction  of 
the  essentiality  to  human  welfare  of  the  sublime  moral  truths 
which  he  proclaimed  in  speech^  realised  in  his  life,  and  suf- 
fered for  in  his  death,  and  quicken  their  sense  of  them,  which 
is  apt  to  grow  dull  in  the  rude  conflicts  of  the  world.  They 
get  strength  and  comfort  to  go  on  the  narrow  way  of  upright- 
ness from  this  assemblincr  of  themselves  toc^ether  in  solemn 
meeting,  out  of  their  consent  of  faith  and  the  infection  of 
sympathy;  for  they  are  beings  of  the  same  kind,  struggling 
with  the  same  trials,  bearing  the  same  sorrows,  and  looking 
forward  to  the  same  end  of  their  labours  under  the  sun.  But 
it  cannot  therefore  be  argued  that  there  is  anything  which 
does  not  come  by  ordinary  mental  laws,  anything  supernatural, 
in  the  moral  enthusiasm  which  is  kindled  in  these  circum- 
stances ;  if  a  number  of  persons  were  gathered  together  in 
the  same  sympathetic  ^vay  to  fan  some  unwise  emotional  ex- 
citement and  to  do  some  foolish  thing,  as  for  example  to  dance 
and  shake  furiously  after  the  manner  of  the  Shakers  until 
they  were  exhausted,  the  excitement  would  be  augmented,  and 
the  infection  of  it  would  spread  by  sympathy  in  the  same  way. 


158  PATHOLOGY  OF  MIND.  [chap. 

The  infection  of  emotion  has,  as  history  shows,  given  rise  to 
many  moral  epidemics.  However  plainly  we  acknowledge  the 
operation  of  law  in  human  thought,  feeling,  and  conduct,  there 
must  always  be,  so  long  as  men  continue  to  be  of  the  same 
hind,  and  susceptible  therefore  to  the  infection  of  a  common 
emotion,  so  long  as  no  favoured  ones  among  them  rise  to  the 
level  of  a  higher  kind  from  which  they  can  contemplate  apart 
with  God-like  serenity  the  doings  of  their  former  fellows,  a 
quio-k  feeling  of  personal  and  social  concern  with  respect  to 
the  operation  of  moral  law  which  there  is  not  with  respect 
to  the  operation  of  physical  law  ;  and  from  this  feeling  it  is 
that  we  derive  the  ethical  impulse,  the  imperative  moral  man- 
date, which  accompanies  the  perception  of  the  right  w^ay  to  take 
to  promote  human  weal  and  dictates  the  duty  to  take  it. 

It  may  be  anticipated  perhaps  that  the  time  will  come,  though 
it  is  yet  afar  off,  when  the  feelings  of  anger  and  retaliation 
which  are  now  roused  by  criminal  and  vicious  doings  will  be 
extinct,  and  wdien  those  who  perpetrate  them  will  be  thought  so 
irrational  as  to  be  looked  upon  with  the  same  feelings  with 
which  lunatics  are  looked  upon  now.  In  this  relation  it  is 
instructive  to  take  notice  how  complete  a  revolution  in  the 
feeling  with  regard  to  the  insane  has  taken  place  within  the 
last  half  century,  with  increase  of  knowledge  of  what  insanity  is: 
their  irrational  beliefs  and  turbulent  deeds  roused  indignation 
formerly,  and  were  dealt  with  by  harsh  measures  of  punishment, 
as  if  they  were  voluntary  ;  now,  however,  since  better  know- 
ledge of  insanity  has  been  gained,  those  who  have  to  do  with 
the  insane  look  upon  their  delusions  with  curiosity  or  compas- 
sion, and  are  not  moved  to  anger  by  their  perverse  and  violent 
deeds ;  however  much  annoyed  or  distressed  by  them,  they 
would  no  more  think  of  getting  angry  and  retaliating  by 
punishments  than  they  would  think  of  punishing  an  unwelcome 
rainy  day ;  but  it  is  instructive  also  to  note  that  the  old 
sentiments  still  linger  in  the  breasts  of  ignorant  people,  and  are 
vigorously  expressed  in  outbursts  of  angry  vengeance  whenever 
an  insane  person  who  has  done  homicide  is  rescued  from  the 
gallows.  It  were  a  good  thing  if  men  could  reach  the  same 
height  of  philosophy  in  contemplating  the  evil  doings  of  their 


IV.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      159 

fellows  who  are  not  in  lunatic  asylums  :  if  instead  of  being 
embittered  by  treacherous  dealing,  afflicted  by  evil  speaking  and 
slandering,  soured  by  ingratitude,  made  revengeful  by  wrong, 
angered  by  stupidity,  they  could  look  upon  such  things  as 
natural  and  inevitable  events,  much  as  they  look  upon  the 
vagaries  of  insanity  or  upon  bad  weather,  and  be  nowise  dis- 
quieted by  them.  Such  attitude  of  mind  need  not  in  the  least 
preclude  suitable  steps  being  taken  to  frustrate  acts  of  treachery 
and  to  render  criminals  harmless,  any  more  than  it  now  pre- 
cludes the  adoption  of  the  necessary  measures  to  place  lunatics 
under  proper  care  and  control. 

Passing  from  consideration  of  the  general  method  and  aim  of 
true  education,  I  may  point  out  that  the  sound  and  strong 
character  which  it  might  be  expected  to  form  would  be  well 
fortified  against  some  of  the  most  common  exciting  causes  of 
insanity — those  passions,  namely,  which  often  make  shipwreck 
of  the  mental  health ;  for  the  passions  are  like  the  wind  which 
swells  the  sail,  but  sometimes,  when  it  is  violent,  sinks  the  ship. 
To  get  rid  of  an  overweening  conceit  of  self,  by  bringing  home 
to  the  individual  true  conceptions  of  his  humble  relations  and 
subordinate  purpose  in  nature — which  I  take  to  be  one  good  use  of 
the  overwhelming  immensity  of  the  heavens  and  of  the  revolving 
multitudes  of  stars — would  help  to  moderate  and  control  the 
emotional  or  affective  element  in  his  nature,  inability  to  moderate 
and  control  which  is  real  slavery ;  and  to  do  that  would  be  to 
£fet  rid  at  one  stroke  of  the  so-called  moral  causes  of  mental 
disease.  Sorrow  for  loss  of  fortune  or  loss  of  friend,  envies, 
hatreds  and  jealousies,  disappointed  ambition,  the  wounds  of 
exaggerated  self-love,  anxieties  and  apprehensions,  and  similar 
heartaches,  all  of  which  have  their  footing  in  a  keen  self-feeling, 
and  gain  undue  activity  from  the  w^ant  of  a  proper  development 
of  the  rational  part  of  the  nature,  would  not  then  produce  that 
instability  of  equilibrium  which  goes  before  the  overthrow  of 
the  mental  balance.  What  hold  could  disappointed  ambition 
have  upon  him  who  soberly  weighed  at  their  true  value  the 
common  aims  of  worldly  ambition,  who  perceived  the  degrada- 
tion to  be  gone  through  in  order  to  attain  them,  who  foretasted 
the  bitterness  of  achieved  success  when  they  were  attained,  and 
8 


160  PATHOLOGY  OF  MIND.  [o:iap. 

who  set  before  himself  definitely  as  his  true  aim  in  life,  for 
which  he  worked  definitely,  the  highest  development  of  which 
his  intellectual  and  moral  nature  was  capable  ?  His  heart 
could  never  be  deeply  corroded  by  envy  who  cared  not  whether 
he  did  a  great  thing  or  whether  somebody  else  did  it,  the  only 
true  concern  being  that  it  should  be  done,  whose  imagination 
realised  the  littleness  and  the  transitoriness  of  the  greatest  of 
great  fames,  and  whose  clearly  conceived  and  steadfastly  pursued 
aim  it  was  to  reach  a  passionless  serenity  of  mind.  There  could 
be  no  overwhelming  grief  from  loss  of  fortune  in  him  who 
appraised  at  its  true  value  that  which  fortune  can  bring,  and 
that  which  fortune  can  never  bring ;  nor  would  he  be  hurt  by 
the  pangs  of  wounded  self-love  who  saw  before  him  as  final  end 
absorption  of  self  into  the  all,  and  had  learned  and  practised  as 
means  thereto  the  lesson  of  self-renunciation. 

If  it  be  said  that  this  ideal  of  education  is  hardly  within  the 
reach  of  any  one,  and  far  beyond  the  reach  of  the  great  mass  of 
mankind,  who  would  drift  from  all  moral  anchorage  were  they 
loosed  from  the  bondage  of  religious  creed,  I  answer  that  it  is 
not  really  more  out  of  reach  than  the  ideal  of  Christian  life  and 
doctrine ;  that  it  is  seen  to  be  the  goal  of  the  road  on  which 
men  are  actually  travelling  so  far  as  they  go  forward  in  evolu- 
tion, and  not,  like  the  Christian  ideal  of  doctrine,  a  point  which 
is  more  and  more  divergent  with  every  step  forward  which  they 
make  in  real  life  and  thought ;  and  finally,  that  a  high  ideal  to 
aim  at,  so  long  as  it  is  not  absurdly  impracticable,  is  an  excellent 
means  of  training,  it  being  the  pursuit  and  not  the  achievement 
which  makes  the  pleasure  and  profit  of  labour.  Any  one  who 
makes  a  searching  examination  of  the  varieties  of  human  feeling 
which  are  correlated  with  the  different  sorts  and  conditions  of 
human  life  may  convince  himself  that  it  is  a  baseless  opinion 
that  men  would  cease  to  have  moral  feeling  if  they  ceased  to 
believe  in  heaven  and  hell ;  they  never  can,  nor  ever  do,  free 
themselves  from  the  ever-present  and  ever- working  influence  of 
the  social  organization  of  which  they  are  units;  being  of  the 
same  kind,  the  kind  is  in  them,  and  shows  itself  in  common 
feeling.  If  the  social  medium  be  no  better  than  one  of  thieves 
and  harlots,  there  will  still  be  formed,  as  there  always  is,  a 


IV.]        TUE  Cx\USATION  AND  PREVENTION  OF  INSANITY.       161 

particular  tliief's  conscience  or  harlot's  conscience,  to  violate 
which  will  occasion  uneasiness  of  mind  or  be  thou2;ht  to  brini^ 
ill-luck  :  the  peculiar  sort  of  honour  which  exists  among  thieves 
and  among  prostitutes  is  not  derived  from  any  perverted  abstract 
feeling  of  right  and  wrong,  but  is  developed  as  a  necessary  con- 
dition of  their  living  together  in  any  sort  of  social  harmony. 
It  is  notorious  that  a  man  of  honour,  so-called,  would  be  more 
disgraced  among  his  fellows  by  his  refusal  to  pay  a  gambling 
debt  than  he  would  be  by  perpetrating  a  heartless  seduction :  the 
conventional  feeling  of  the  society  in  which  he  moves  is  more 
powerful  than  a  higher  moral  feeling.  Men  are  found  every- 
where to  seek  that  which  brings  them  fame  and  reputation,  and 
to  avoid  that  which  brings  them  shame  and  dishonour  amonfj 
their  kind,  although  that  which  is  esteemed  may  be  profoundly 
immoral,  and  that  which  is  despised  may  be  essentially  noble. 
"Where  riches  are  in  credit,"  says  Locke,  as  though  he  had 
forethought  of  the  England  of  to-day,  "  knavery  and  injustice 
that  produce  them  are  not  out  of  countenance,  because,  the 
state  being  got,  esteem  follows  it,  as  in  .some  countries  the  crown 
ennobles  the  blood."  These  examples  go  to  show  the  error  of 
the  opinion  that  the  formation  and  the  power  of  a  moral  sense 
depend  upon  a  belief  in  a  supernatural  power  and  in  a  future 
life ;  it  is  impossible  that  men  should  dwell  together  in  unity, 
as  they  do  in  complex  society,  without  the  development  and 
function  of  moral  sense. 

It  will  be  the  aim  of  a  wise  self- training  to  develop  true 
thoughts  and  sound  feelings  in  the  mind,  and  so  to  coordinate 
them  in  exercise  that  they  shall  be  available,  when  required,  as 
the  best  volition ;  and  the  means  to  this  end  are  not  observation 
and  reflection  only,  but  more  particularly  action.  The  formation 
of  character  is  a  slow  and  gradual  process  which  goes  on  in 
rr4ation  with  the  circumstances  of  life :  what  men  do  habitually 
that  they  will  be.  It  is  useless  to  give  advice  that  runs  counter 
to  the  affinities  of  a  character  which  has  been  formed  by  a  life- 
exercise  ;  it  cannot  assimilate  it.  He  who  has  always  done  ill 
will  find  it  as  hard  to  amend  his  ways  and  do  well  as  one  who 
has  always  spoken  English  to  speak  another  language ;  as  he 
must  learn  speech  by  speaking,  so  he  must  learn  well-doing  by 


162  PATHOLOGY  OF  MIND.  [chap. 

doing  well.  "  Cease  to  do  evil,  learn  to  do  well,"  is  the  maxim 
of  a  sound  mental  philosophy.  The  proper  counsel  of  a 
physician  to  one  who  consults  him  concerning  what  he  shall  do 
to  be  saved,  because  of  a  well-grounded  apprehension  that  his 
mind  will  give  way,  would,  were  it  candid  and  compendious, 
oftentimes  be — Learn  to  unlearn.  I  have  often  felt  despair  when 
I  have  been  asked  anxiously  by  such  a  one  what  books  he 
should  read  in  order  to  fortify  his  mind  against  insanity ;  for  the 
hopeless  problem  presented  was  how  to  efface  in  a  day  the 
growth  of  a  life — nay,  perhaps  of  a  line  of  lives — how  to  undo  a 
mental  organization.  If  there  has  not  been  sound  discipline  to, 
guide  the  growth  of  character  through  the  stages  of  its  gradual 
formation,  there  will  be  small  hope  of  bending  it,  when  it  is 
formed,  to  new  trains  of  thought  and  feeling. 

Every  nature  has  its  particular  tendencies  of  development 
which  may  be  fostered  or  checked  by  the  circumstances  of  life, 
and  which,  according  as  they  are  of   good  or  bad  kind,  and 
according  to  the  external  influences  which  they  meet  with,  may 
minister  to  his  future  weal  or  woe.     Too  often  it  happens  that 
an  injudicious  training  aggravates  an  inherent  fault.     Parents 
who,  having  themselves  a  weak  strain  in  their  nature,  have 
given  their  children  the  heritage  of  a  morbid  bias  of  mind,  are 
very  apt  unwittingly  to  foster  its  unhealthy  development ;  they 
sympathise  so  essentially  with  it  that  they  do  not  perceive  its 
vicious  character  if  they  do  not  actually  admire  it,  as  men  are 
not  offended  by  the  bad  odours  of  their  own  bodies,  and  leave  it 
to  grow  unchecked  by  a  wise  discipline,  or  perhaps  stimulate  it 
by  the  force  of  a  bad  example.    "  He  is  so  spoiled,"  says  the  silly 
mother  placidly  of  her  child,  as  though  she  was  saying  some- 
thing that  was  creditable  to  it,  or  at  any  rate  that  was  not  very 
discreditable  to  her,  little  thinking  of  the  terrible  meaning  of 
the  words,  and  of  the  awful  calamity  which  a  spoiled  life  may  be. 
It  may  justly  be  questioned  whether  the  whole  system  of  edu- 
cation at  the  present  day  does  not  err  on  the  side  of  dangerous 
indulgence.     No  doubt  such  harshness  and  neglect  as  might  be 
likely  to  repress  cruelly  a  child's  feelings,  and  to  drive  it  to  take 
refuge  in  a  morbid  brooding,  or  in  vague  and  visionary  fancies, 
would  be  a  great  wrong,  but  a  foolish  indulgence,  through  which 


IV.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       1G3 

it  never  has  infixed  in  its  nature  the  important  lessons  of  re- 
nunciation and  self-control,  is  not  less  pernicious.  Can  it  be 
"wondered  at  that  persons  whose  minds,  when  they  are  young, 
have  never  been  trained  to  bear  any  unwelcome  burden,  should 
break  down  easily  into  insanity  under  the  strain  of  severe  trials 
in  later  life  ?  The  aim  of  early  education  ought  to  be  sound 
intellectual  and  moral  discipline  rather  than  much  learning  of 
any  sort ;  to  fill  a  child's  mind  with  details  of  knowledge  in 
order  to  make  it  a  prodigy  of  learning  is  likely  enough  to 
prepare  for  it  an  early  death  or  an  imbecile  manhood  ;  but 
nothinsj  can  be  better  than  the  careful  fashionins^  of  its  intellect 
into  a  trained  instrument  by  which  knowledge  may  be  acquired 
readily,  and  with  habits  of  accuracy,  and  the  formation  of  a 
stable  character,  which,  through  the  constant  practice  of  self- 
denial,  obedience,  self-control,  shall  embody  those  lessons  of  a 
good  moral  experience  which  the  events  of  later  life  will  not 
fail  to  enforce  rudely. 

The  common  system  of  female  education,  which  is  now 
falling  fast  to  pieces,  was  ill  adapted  to  store  the  mind  with 
useful  knowledge  and  to  train  up  a  strong  character ;  had  it 
been  designed  specially  to  heighten  emotional  sensibility  and  to 
weaken  reason  it  could  hardly  have  been  more  fitted  to  produce 
that  effect.  Its  whole  tendency  has  been  to  increase  that  predo- 
minance of  the  affective  life  in  woman  which  she  owes  mainly  to 
her  sexual  constitution,  and  the  intellectual  and  moral  outcome 
of  which  is  seen  in  judgment  by  feelings,  in  intuitive  per- 
ceptions rather  than  rational  appreciation,  and  in  conduct 
dictated  by  impulse  rather  than  by  deliberate  will.  Hitherto 
she  has  been  trained  to  no  outlook  but  marriage,  and  to  culti- 
vate only  such  accomplishments  as  might  be  most  useful  to 
attain  that  end ;  through  generations  her  character  has  been  so 
informed ;  when  therefore  the  end  is  missed  all  else  is  missed. 
Disappointed  of  marriage,  to  which  her  whole  nature  tends,  there 
has  been  no  outlet  of  action  in  which  the  energies  of  her  feel- 
ings might  be  discharged  vicariously,  and  she  is  ill  fitted  to 
bear  the  stress  of  disappointment  with  the  long  train  of  conse- 
q^uences,  physical  and  moral,  which  it  draws  after  it. 

Undoubtedly  cases  do  occur  from  time  to  time  of  mental 


1G4  PATHOLOGY  OF  MIND.  [chap. 

derangement  in  unmarried  women,  especially  of  tlie  n])per  and 
middle  classes  which  appear  to  have  been  caused  mainly  by  the 
frustration  of  this  fundamental  instinct  of  their  being,  and  by 
the  want,  in  the  present  social  system,  of  suitable  spheres  of 
activity  in  which  its  energy  might  have  vicarious  expression. 
Between  the  instinctive  impulses  with  the  emotional  feelings 
that  are  connected  with  them  and  the  conventional  rules  of 
society  which  prescribe  the  strictly  modest  suppression  of  any 
display  of  them,  a  hard  struggle  is  not  unfrequently  maintained. 
The  keen  self-feelings  and  passionate  longings,  heightened  to  a 
morbid  pitch  by  continual  brooding,  perhaps  take  a  religious 
guise  as  the  only  channel  through  which  they  can  be  expressed 
freely  without  impropriety  ;  and  the  occasional  result  is  a  form 
of  mental  derangement  marked  by  a  strange  mixture  of  erotic 
feelings  and  religious  visions  or  delusions.  With  the  improve- 
ment of  female  education  and  with  the  new  openings  for  female 
labour  we  may  expect  the  predominance  of  the  affective  life  to 
be  somewhat  lessened,  the  resources  for  work  to  be  systematically 
used,  and  higher  aims  than  frivolous  amusements  to  be  pursued ; 
and  the  reaction  of  a  different  mode  of  life  upon  female  educa- 
tion and  upon  female  nature  cannot  fail  to  be  considerable. 

Thus  much  concerning  education  in  its  bearing  on  the  pro- 
duction of  insanity.  If  the  foregoing  opinions  be  correct,  it  is 
clear  that  any  increase  of  the  disease  which  may  be  taking  place 
now  is  no  proof  that  education  will  always  fail  to  check  such 
increase ;  it  is  an  argument  only  that  a  method  of  education 
which  is  faulty  at  its  foundation  does  not  help  to  prevent  insanity, 
if  it  does  not  actually  help  to  produce  it.  It  is  still  in  the 
working  of  a  sound  education  and  training  that  we  expect  not 
only  to  neutralize  a  predisposition  to  mental  derangement  in 
the  individual,  but  to  counteract  any  tendency  to  an  increase 
thereof  in  the  community  which  may  spring  from  the  evils 
accompanying  the  benefits  of  civilisation  ;  the  external  advan- 
tages of  which  may  naturally  lead  in  the  end  to  a  better  in- 
ternal culture,  so  furnishing  in  its  higher  stages  a  remedy  for 
some  of  the  mischief  which  it  produces  in  its  earlier  stages. 

Sex. — It  has  been  a  disputed  question,  which  is  not  yet  settled 
definitely,  whether  more  men  than  women  go  mad.     Esquirol 


IV.]       THE  CAUSATION  AND  PllEVENTION  OF  INSANITY.      1(35 

tlioiiglit  that  men  more  often  went  wrong,  but  lie  omitted  in  his 
calculations  to  take  sufficient  account  of  the  preponderance  of 
women  in   the  population,  that  preponderance   being   greatest 
between  the  very  ages  of  twenty  and  forty,  when  insanity  most 
often  occurs,   and  he  was  also  led  astray  by  drawing  his  con- 
clusions from  a  comparison  of  the  existing  cases  instead  of  the 
occurring  cases  in  the  two  sexes.     It  is  worthy  of  remark  that 
more  male  than  female  children  are  born :  in  Ensjland  durin" 
ten  years  (from  1857  to  1866)  the  proportion  of  male  children 
born   alive  to   females  was   about  104"5    to    100  ;    in   France 
during  44  years  it  was  106-2  to  100 ;  in  Eussia  the  average 
proportion  was  108*9  to  100;  among  Jews  it  is  higher  still; 
but  inasmuch  as  more  males  are  stillborn  than  females,  as  more 
die  early,  especially  during  the  first  year  of  life,  and  as  more 
perish  by  accident  or  emigrate,  it  comes  to  pass  in  the  end  that 
females  preponderate  in  old  settled  countries.     Out  of  a  popu- 
lation of  24,854,397  in  England  and  Wales  there  were  12,097,547 
males,  and  12,756,850  females,  and  of  these  on  January  1st,  1878, 
31,024  males  and  37,514  females  were  known  to  be  insane.    The 
ratio  of  male  lunatics  to  the  population  was  25*64  per  10,000, 
that  of  female  lunatics  29"40  ;  and  pretty  nearly  the  same  rela- 
tion will  be  found  to  hold  for  the  corresponding  ratios  of  the 
last  eighteen  years.^     We  may  take  it  then  that  the  excess  of 
female  lunatics  is  greater  than  is  accounted  for  by  the  excess  of 
the  female  population,  and  that  some  other  cause  or  causes  must 
be  sought  for  to  explain  it.     In  matter  of  fact  the  number  of 
men   actually   admitted   into   asylums,   which   may   be   taken 
roughly  but  fairly  to  represent  the  number  of  occurring  cases 
among  men,  is  found,  when  the  records    of  asylums  are   ex- 
amined, to  be   considerably  above  that  of  female   admissions. 
One  cause  of  the  preponderance  of  female  lunatics  certainly  is 
the  much  greater  proportionate  mortality  among  male  lunatics, 
this  being  due  mainly  to  the  fatality  of  a  single  disease,  namely, 
general   paralysis,    which  is    almost   confined   to  men,  seldom 

^  Among  private  lunatics  the  ratio  is,  and  always  has  been,  higher  for 
males,  being  3*45  against  2 '76  for  females  per  10,000.  One  reason  pro- 
bably is  that  it  is  easier  to  keep  insane  females  at  home  among  classes 
above  paupers. 


166  PATEIOLOGY  OF  MIND.  [chap. 

attacking  women  ;  and  to  this  main  cause  may  be  added  another 
subsidiary  cause,  namely,  the  greater  proportion  of  relapses  wliicli 
has  been  observed  to  take  place  in  women.  For  these  reasons 
it  is  that  women  accumulate  in  asylums  more  than  men  ;  and 
this  accumulation,  taken  in  connection  with  the  excess  of 
females  in  the  population,  is  probably  enough  to  account  for  the 
excess  of  existing  female  insanity. 

Dr.  Thurnam  concluded  at  the  end  of  his  patient  inquiries 
that  men  were  more  liable  to  mental  derangement  than  women  ; 
and  that  is  the  general  belief  now.  Granting  it  to  be  true,  it 
must  not  therefore  be  supposed  that  it  is  because  of  anything 
in  the  constitution  of  men  which  renders  them  more  liable  to 
such  derangement ;  on  the  contrary,  there  are  obviously  dis- 
turbing conditions  peculiar  to  the  female  constitution  which  are 
more  fitted  to  be  occasions  of  mental  disorder — to  wit,  the  con- 
stitutional change  at  puberty,  pregnancy,  child-bearing  and  its 
sequences,  and  the  climacteric  change,  with  each  one  of  which 
we  can  connect  a  definite  variety  of  insanity.  The  true  reason 
no  doubt  why  more  men  go  mad  is  that  they  are  exposed  in  the 
strugges  of  life  to  more  numerous,  varied,  and  powerful  causes 
of  mental  disturbance.  The  strain  of  work  for  competence  or 
wealth,  the  anxieties  and  apprehensions  of  business,  the  burden 
of  family  responsibilities  weigh  more  heavily  as  a  rule  upon 
men  who  are  the  bread-winners  than  upon  women  ;  intemperance 
again,  which  is  one  of  the  most  active  causes  of  insanity,  is  a 
much  more  active  cause  among  men  than  among  women ;  and 
there  are  other  excesses,  especially  sexual  excesses,  to  which 
they  are  more  prone  and  which  do  them  more  hurt  than  they 
do  women.  In  fact  these  three  classes  of  effective  causes  are 
enough  to  outweigh  the  greater  tendency  to  mental  disorder 
which  lies  in  the  nature  and  functions  of  the  female  organization, 
as  well  as  the  nervous  instability  which  women  acquire  in  the 
present  social  system  by  reason  of  defective  education,  aimless 
lives,  frivolous  amusements,  and  the  lack  of  resources  of  work. 
The  right  conclusion  at  the  end  of  the  whole  matter  would 
seem  to  be  that  while  there  is  no  very  sensible  and  certain 
difference  between  the  proportions  of  men  and  women  who 
become  insane,  as  the  causes  actually  operate,  men  are  exposed 


IV.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       167 

to  more  numerous  and  powerful  extrinsic  causes,  and  women, 
by  virtue  of  their  sexual  organization,  to  more  numerous  and 
powerful  intrinsic  occasions,  of  insanity.  In  proportion  as 
women  invade  those  departments  of  work  which  men  have 
hitherto  appropriated  they  will  expose  themselves  more  and 
more  to  those  extrinsic  causes  of  derangement,  and  it  is  a  grave 
question  whether  they  will  not  find  themselves  overborne  by 
the  joint  action  of  the  weight  from  without  and  the  weakness 
within. 

Age. — I  have  pointed  out  already  that  the  relative  activity  of 
different  organs  and  tissues  at  different  ages  plays  some  part  in 
the  occurrence  of  particular  diseases  at  those  ages,  and  that 
it  is  especially  so  when  there  is  an  organic  predisposition  to 
disease.  It  is  not  surprising  then  that  mental  derangement  is 
uncommon  before  puberty ;  for  up  to  that  time  the  part  of  the 
nervous  system  which  ministers  to  muscular  action  is  in  active 
function,  and  the  consequence  is  that  epilepsy  is  the  most 
common  nervous  disease.  Still  all  forms  of  insanity  except 
general  paralysis  do  occur  even  so  early  in  life.  Most  often  it 
has  then  the  character  of  mental  defect,  and  may  be  classed 
under  idiocy  or  imbecility ;  the  mental  organization  being  in- 
complete, its  disorders  bear  witness  to  its  undeveloped  state. 
Even  those  cases  which  are  described  as  examples  of  mania, 
because  of  great  excitement  and  activity  of  mind  and  body, 
might  in  most  instances  not  unfitly  be  classed  as  cases  of 
idiocy  or  imbecility  with  maniacal  excitement.  At  first  sight 
it  is  surprising  enough  that  striking  examples  of  moral  insanity 
should  be  met  with  in  quite  young  children ;  but  it  is  certain 
that  instances  do  occur  not  of  true  moral  imbecility  only,  where 
the  unfortunate  beings,  who  are  perhaps  not  of  quite  normal 
intelligence,  have  been  born  without  the  least  capacity  of  moral 
feeling,  but  instances  also  of  active  display  of  all  sorts  of 
immoral  impulses  with  acute  intelligence  of  the  purely  selfish 
and  cunning  type.  Between  the  ages  of  sixteen  and  twenty- 
five  insanity  is  more  frequent,  because  of  the  great  revolution 
which  then  takes  place  in  body  and  mind,  of  the  new  passions 
which  spring  up,  and  of  the  fresh  start  in  mental  development 
which  is  made ;  but  it  is  most  frequent  of  all  during  the  period 


168  PATHOLOGY  OF  MIND.  [chap. 

of  fall  mental  and  bodily  development — from  twenty -five  to 
forty-five  years  of  age — when  the  functions  are  most  active  and 
when  there  is  the  widest  exposure  to  causes  of  disorder.  The 
internal  revolution  which  takes  place  in  women  at  the  climac- 
teric period  leads  to  many  outbreaks  of  melancholic  derangement 
between  forty  and  fifty  ;  and  it  has  been  thought  that  a  sort  of 
climacteric  change  occurs  in  men  also,  usually  between  fifty  and 
sixty,  when  insanity  sometimes  shows  itself.  In  old  age  senile 
dementia  is  the  most  common  form  of  derangement;  it  is  the 
pathological  term  of  the  natural  decay  of  mind  which  occurs 
when  nature — ■ 

"  As  it  grows  again  towards  eartli, 
Is  fasliioned  for  the  journey,  dull  and  heavy." 

Occu]pcdion  and  Condition  in  Life. — Whether  one  profession, 
trade,  or  pursuit  more  than  another  favours  the  occurrence  of 
insanity  is  not  really  so  much  a  question  of  the  effect  of  the 
particular  pursuit  as  of  the  habits  of  those  who  follow  it  and  of 
the  spirit  in  which  they  follow  it.     Among  the  lower  classes  of 
society  it  is  for  the  most  part  a  question  of  sobriety  and  tem- 
perance against  intemperance  and  riotous  living.     In  the  classes 
that  are  above  the  lower,  Avhen  a  man  sets  before  himself  as 
his  aim  in  life  riches  or  social  position,  not  for  any  good  use  of 
what  he  gets  by  his  toil  and  cares  and  heartburnings,  but  as 
an  end  in  itself,  let  his  business  be  what  it  will,  he  is  pursuing 
a  not  very  worthy  end,  and  will  be  likely  to  do  so  in  an  in- 
temperate way,  if  not  by  actually  unworthy  means.      If  the 
social  system  be  one  in  which  riches  are  held  in  great  esteem, 
and  his  passionate  ambition  is  to  get  rich,  he  will  not  boggle 
much  at  the  knavery  which  helps  him  to  his  end,  and  which 
will  be  overlooked  by  such  a  society  in  the  admiration  which 
it  bestows  upon  success.     Even  when  a  man  has  made  success 
or  reputation  in  business  the  exclusive  aim  of  his  life,  not  out 
of  a  mere  desire  to  become  rich,  but  out  of  an  eager  energy 
and  honest  love  of  doing  his  work  well ;  when  he  has  by  long 
concentration  of  desire  and  work  upon  it  grown  so  completely  to 
it  as  to  make  it  the  entire  current  of  his  life,  that  to  which  all  his 
thoughts,  feelings,  and  actions  turn  habitually,  and  in  which  they 


IV.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      KV.i 

are  engrossed — other  interests  being  as  it  were  little  and  acci- 
dental eddies  that  escape  for  a  short  time  only  the  attraction  of 
the  main  stream — he  is  ill  fortified  by  mental  culture  against 
the  shock  when  hope  is  shattered,  his  pride  of  opinion  brought 
low,  and  the  fabric  wdiich  he  has  raised  with  all  the  eaQ;erness 
and  energy  of  an  intense  egoism  levelled  to  the  ground  by  a 
crushing  blow  of  misfortune.  Nay,  the  belief  only  that  such  a 
catastrophe  is  threatened  may  be  enough  to  overthrow  him ;  for 
if  nine  out  of  ten  parts  of  his  being  and  energies  are  absorbed 
in  the  successful  prosecution  of  his  work,  and  that  has  had  a 
severe  check,  where  is  an  adequate  recuperative  and  distracting 
force  to  come  from  ?  He  is  not  unlikely  to  sink  into  an  agitated 
apprehension,  and  from  that  state  to  lapse  into  despairing 
melancholy. 

It  was  a  common  notion  at  one  time  that  governesses  were 
victims  of  insanity  out  of  all  proportion  to  their  numbers,  and 
much  sympathy  was  spent  upon  them  in  consequence.  But  the 
opinion  was  not  well  founded.  It  originated  in  the  observation 
that  a  great  number  of  governesses  were  received  into  Bethlehem 
Hospital — as  many  as  110  in  ten  years ;  the  reason  of  w^hich 
was  not  that  so  many  more  of  them  than  of  other  classes  w^ent 
mad,  but  that  they  were  just  the  persons  who  fulfilled  best  the 
conditions  of  charitable  admission  into  that  hospital,  being  poor 
enough  to  be  unable  to  pay  for  care  and  treatment  in  private 
asylums,  but  yet  not  poor  enough  to  be  paupers  and  suitable 
for  admission  into  county  asylums. 

If  it  be  true,  as  is  said,  that  persons  who  work  with  the  head 
are  more  liable,  on  the  whole,  to  mental  disease  than  those  who 
work  with  the  hand,  and  that  they  are  less  lilvcly  to  recover  when 
they  have  had  an  attack,  we  may  easily  understand  the  reason 
to  be  that  a  more  complex  and  delicate  mental  organization,  with 
its  greater  variety  and  activity  of  function,  will  furnish  more 
frequent  occasions  of  disorder,  and  that  the  disorder  will  do 
greater  hurt  to  the  finer  and  more  delicate  instrument.  But  it 
would  probably  be  a  fuller  statement  of  the  truth  to  supplement 
it  l)y  adding  that  those  who  work  wdtli  the  heart  are  more  likely 
to  fall  insane  than  either  headworkers  or  handworkers ;  for  the 
causes  of  the  derangement  are  to  be  found  not  so  much  in  the 


no  PATHOLOGY  OF  MIND.  [chap. 

strain  of  tlie  intellectual  work  as  in  tlie  passion  and  feeling 
which  are  put  into  it,  and  which  are  the  real  wearing  force.  It 
is  not  in  fact  the  nature  of  the  occupation,  but  the  temperament 
of  the  individual,  which  determines  mainly  what  emotional  wear 
and  tear  there  shall  be ;  one  person  may  fret  and  consume  his 
heart  with  anxiety  in  the  small  cares  of  a  petty  business,  while 
another  shall  conduct  the  complex  affairs  of  a  mighty  nation 
.  with  unconcern  of  feelinsr. 

All  privileged  or  so-called  aristocratic  classes  have  in  their 
privileges  the  conducive  elements  of  corruption  and  decay,  and 
degeneracy  of  one  sort  or  another  is  likely,  sooner  or  later,  to 
appear  and  spread  among  them.  Doubtless  it  is  a  good  and 
praiseworthy  thing  to  reward  eminent  service  to  the  state  by 
conferring  honours  and  privileges  upon  the  deserving  individual ; 
but  that  such  privileges  should  descend  as  a  heritage  to  his  pos- 
terity for  ever,  whatever  their  quality,  is  a  custom  which,  were  it 
proposed  to  be  established  now  for  the  first  time,  would  pro- 
bably be  encountered  with  incredulous  amazement.  The  matter 
is  of  course  w^orse  when  the  honour  is  conferred  for  services 
which  mark  the  dishonour  of  those  who  have  rendered  them. 

A  nation  which  wishes  well  to  itself  will  aim  to  unite  its 
people  in  the  bond  of  unity,  brotherhood,  and  equality,  not  to 
divide  them  into  privileged  social  castes  and  orders.  It  is  im- 
possible to  say  positively  what  degree  of  truth  there  is  in  the 
often  made  statement  that  insanity  is  of  disproportionate  fre- 
quency among  the  so-called  aristocracy  of  this  and  other  countries. 
If  it  be  true,  one  reason  may  be  too  close  and  too  frequent  inter- 
marriages such  as  are  likely  to  occur  where  clanship  prevails, 
and  do  occur  certainly  in  royal  families.  In  this  country,  how- 
ever, we  observe  powerful  causes  silently  working  to  break  down 
the  exclusive  barriers  of  caste  and  to  widen  the  area  of  selec- 
tion for  breeding ;  a  wealthy  banker,  brewer,  gin-distiller,  con- 
tractor, manufacturer,  or  person  of  that  kind  of  consequence, 
who  has  gained  all  the  wealth  which  his  heart  desires,  is  com- 
monly an  unsatisfied  man  until  he  has  wriggled  into  a  higher 
social  position,  and,  more  blessed  still,  has  allied  himself  or  his 
family  by  marriage  to  some  titled  family  ;  and  the  younger  sons 
and  the  daughters  of  titled  families  who,  owing  to  the  law  of 


IV.]       THE  CAUSATION  AND  PEEVENTION  OF  INSANITY.       171 

entail  and  the  privileges  of  primogeniture,  are  needy  in  proportion 
to  their  pretensions,  gladly  seek  by  marriage  into  wealthy  com- 
mercial families  the  means  to  support  their  social  position.  It 
may  be  doubted  whether  such  marriages  commonly  turn  out 
well  so  far  as  health  and  vigour  of  offspring  are  concerned. 
The  reasons  I  take  to  be  these :  first,  that  men  who  have  made 
it  the  sole  work  of  their  lives  to  get  money,  and  having  got  it 
have  had  no  higher  aim  than  to  use  it  to  gratify  a  contemptible 
social  passion,  are  not  such  as  are  likely  to  breed  sound  moral 
constitutions  in  their  children;  and,  secondly,  that  the  needy 
members  of  titled  families  who  sell  themselves  for  subsistence 
instead  of  earning  it  by  honest  labour  are  as  little  likely  to  be 
fitted  to  breed  well. 

There  seems  to  be  no  doubt  that,  other  things  being  equal, 
insanity  is  more  frequent  among  unmarried  than  among  married 
persons :  a  fact  of  which  it  is  not  difficult  for  an  ingenious 
person  to  invent  several  theoretical  explanations. 

One  consideration  more  it  will  be  proper  to  take  notice  of 
before  leaving  this  subject.  Over- population,  which  prevails  in 
some  civilised  countries,  is  the  cause  of  numerous  ills  to  man- 
kind, amongst  which  we  may  probably  reckon  an  increase  of 
mental  disorders.  In  the  eager  and  active  struggle  for  existence 
which  goes  on  where  the  claimants  are  many  and  the  supplies 
are  limited,  and  where  the  competition  therefore  is  fierce,  the 
weakest  must  needs  suffer,  and  some  of  them,  oppressed  by 
poverty,  fretted  by  constant  cares,  and  overwhelmed  by  anxieties, 
will  break  down  into  madness.  Moreover  the  overcrowded  and 
unhealthy  condition  of-  dwelling-houses  which  over-population 
occasions  cannot  fail,  in  conjunction  with  insufficient  nourish- 
ment, to  lead  to  deterioration  of  the  health  of  the  community, 
and  so  to  predispose  to  disease  of  different  sorts.  Not  fevers 
only  and  epidemic  diseases,  but  scrofula,  phthisis,  and  other 
constitutional  states  marked  by  general  deterioration  of  nutrition, 
are  engendered  and  transmitted  as  evil  heritage  from  generation 
to  generation. 

It  is  not  that  the  child  inherits  necessarily  the  particular 
disease  from  which  the  parent  suffered,  but  it  inherits  probably 
a  constitution  in  which  there  is  an  inherent  aptitude  to  some 


172  PATHOLOGY  OF  MIND.  [chap. 

kind  of  morbid  degeneration,  or  which  is  destitute  of  the 
reserve  force  necessary  to  meet  successfully  such  extraordinary 
strains  as  the  trying  occasions  of  life  cannot  fail  to  exact  some- 
times. Disease  not  being,  as  it  was  so  long  thought  to  be,  a 
specific  morbid  entity  which,  like  some  evil  spirit,  takes  hostile 
possession  of  the  body  or  of  a  particular  part  of  it,  and  must 
be  expelled  by  some  specific  drug,  but  a  state  of  greater  or  less 
degeneration  from  healthy  life  in  an  organism  whose  different 
parts  constitute  a  complex  and  harmonious  whole,  it  is  plain 
that  a  disease  of  one  part  of  the  body  will  not  only  affect 
the  whole  sympathetically  at  the  time,  but  may  well  lead  to  a 
more  general  infirmity  of  constitution  in  the  next  generation. 
Whatever  weakens  the  organism  of  the  mother  may  certainly 
be  a  cause  of  idiocy  of  the  offspring,  especially  when  the  debili- 
tating cause  acts  during  pregnancy.  No  doubt  the  special 
morbid  outcomes  of  the  inborn  infirmity  will  be  determined 
in  some  measure  by  the  external  conditions  of  life :  we  ought 
always  to  take  into  account  the  without  as  well  as  the  within. 
If  a  person  has  inherited  a  generally  feeble  constitution,  and  if 
the  circumstances  of  his  life  chance  to  be  such  as  put  a  great 
strain  upon  his  brain  and  nervous  system,  he  is  not  unlikely 
to  suffer  from  some  form  of  mental  or  nervous  disorder :  the 
man,  for  example,  who  has  responsibilities  to  which  he  feels  him- 
self unequal,  or  is  harassed  by  pecuniary  anxieties  or  by  domestic 
troubles,  or  the  woman  whose  life  a  worthless  husband  makes  a 
daily  round  of  dreary  suffering,  will  show  the  general  want  of 
constitutional  reserve  force  by  the  derangement  of  the  special 
organ  on  which  the  strain  falls. 

It  is  natural  to  feel  sympathy  with  madmen  v/hen  one  sees 
how  the  fine  and  sensitive  nature  of  one  has  broken  down 
under  the  wearing  grind  of  the  coarse  and  rude  experiences  of 
life;  how  the  thoughts  of  another  have  oftentimes  deviated 
from  the  beaten  track  into  brilliant  flashes  of  quick  insight ; 
how  eagerly  animated  with  the  spirit  of  enthusiasm  a  third  has 
shoAvn  himself;  but  while  sympathizing  with  their  sufferings 
and  their  fate,  we  must  still  confess  that  their  failure  meant 
weakness,  and  that  they  succumbed  because  it  was  right  they 
should  succumb.     Albeit  it  is  a  sad  thing  to  see  a  person  fall 


IV.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      173 

from  a  heiglit  and  break  his  neck,  it  would  perhaps  he  a  sadder 
thing  for  the  haw  of  gravitation  to  he  suspended  for  a  moment 
in  order  to  save  his  neck,  and  for  the  universe  to  go  to  wreck. 
It  is  sad  to  contemplate  the  spectacle  of  Lear,  driven  mad  by 
his  daughters'  ingratitude,  and  shrieking  to  the  pitiless  heavens 
in  shrill  senile  lamentations,  but  it  would  be  a  sadder  thing 
in  the  end  if  so  little  insight  into  character,  so  little  prudence, 
and  so  little  self-control  as  he  showed  were  to  issue  in  a 
prosperous  and  peaceable  old  age.  The  aim  of  man's  develop- 
ment being  to  bring  himself  gradually  into  more  and  more 
special  and  complex  relations  with  his  social  and  physical 
environment,  by  intelligent  observation  of  the  laws  which 
govern  these  relations  and  by  corresponding  adaptations  on  his 
part,  he  must  fail  if  he  is  unequal  to  the  struggle  imposed  upon 
him,  whether  it  be  from  inherited  weakness  or  from  any 
other  cause,  just  as  a  tender  plant  must  wither  and  die  in  a 
poor  soil  where  hardier  plants  compete  with  it.  iNay,  he  may 
fail  if  he  is  not  weak,  but  only  unfortunate ;  for  as  one  seed 
may  be  as  sound  and  vigorous  as  another  seed  and  yet  perishes 
if  it  fall  upon  barren  ground,  so  may  a  fairly  strong  man  un- 
haply  chance  upon  evil  circumstances  against  which  he  con- 
tends in  vain.  The  benevolent  observer  could  have  wished  him 
to  have  fallen  upon  better  times  and  among  kinder  surround- 
ings, but  it  is  useless  to  repine ;  he  has  passed  away  as  an  abortive 
being,  and  must  be  counted  one  of  those  countless  germs  whi^h 
nature  sheds  in  lavish  profusion,  and  never  brings  to  develop- 
ment. 

In  a  certain  sense  then  one  may  take  comfort  and  be  glad 
intellectually  that  failures  should  fail ;  for  if  the  weak  were  not 
defeated  in  the  struggle  for  existence,  it  would  be  because  the 
strong,  holding  back  to  the  slower  pace  of  their  infirmities,  used 
not  their  strength,  and  so  robbed  the  world  of  the  right  which 
it  has  to,  and  the  advantage  which  it  would  get  from,  the  full 
use  of  their  superior  powers.  An  increase  of  mental  disease  in 
a  country  means  not  necessarily  the  degeneracy  of  the  people ; 
the  capability  of  development  being  the  capability  of  degenera- 
tion, like  height  and  depth  opposite  and  equal,  it  is  not  hard  to 
understand  that  when  progress  is  going  on  actively  retrograde 


174  PATHOLOGY  OF  MIND.  [chap.  iv. 

action  may  be  going  on  side  by  side  with  it,  tliat  madness  may 
be  a  waste  of  the  individual  to  the  profit  of  the  race — dead 
reason  thrown  off  by  vigorous  mental  growth — a  seeming  evil 
which  is  truly  a  phase  in  the  working  out  of  higher  good. 
Man  rises  in  humanization  at  the  cost  of  his  kind,  mounting 
upwards  over  the  ruins  of  the  races  that  have  successively  come 
and  gone  before  him,  and  it  would  be  as  absurd  to  lament  the 
disappearance  of  the  once  mighty  nations  whose  places  now 
know  them  no  more  as  to  lament  the  mental  degeneracy  which 
correlates  mental  progress. 

Thus  much  concerning  the  remote  or  predisposing  causes  of 
insanity.  It  remains  now  to  set  forth  the  direct  or  proximate 
causes  of  defect  or  derangement  of  the  supreme  centres  of  intel- 
ligence. In  doing  this  it  will  be  most  convenient,  and  in  the 
end  most  scientific,  to  group  them  as  the  causes  of  disorder  of 
the  sensori-motor  and  spinal  centres  have  been  grouped^ — in 
other  words,  to  treat  of  the  causation  of  insanity  from  a  patho- 
logical point  of  view. 

■^  The  Physiology  of  Mind. 


CHAPTER   Y. 

THE   CAUSATION   AND    PPvEVENTION    OF    INSANITY    {ContinvM). 

B.  Patliolog'ical. 

The  Proxiraate  Causes  of  Disorder  of  the  Ideational  Nervous 

Centres. 

In  proceeding  to  consider  those  causes  or  intrinsic  conditions 
wliich,  more  immediately  going  before  mental  disorder,  may  be 
called  proximate,  I  sliall  first  treat  briefly  of  the  actual  defects, 
observed  or  inferred,  of  structure  and  of  development  in  the  in- 
teilectorium  commune.  I  treat  of  them  because  it  is  necessary 
to  give  a  general  idea  of  what  is  known  concerning  them  now, 
and  I  treat  of  them  briefly  only,  because  what  is  known  yet 
is  but  a  hint,  as  it  were,  of  what  remains  to  be  discovered 
hereafter. 

1.  Original  Differences  in  the  Constitution  of  the  Supreme 
Nervous  Centres. — Undoubtedly  there  exist  great  natural  differ- 
ences between  different  people  in  respect  of  the  development  of 
their  cerebral  convolutions.  In  the  lower  races  of  men  these  are 
visibly  less  complex  and  more  symmetrical  than  in  the  higher 
races  ;  the  anatomical  differences  going  along  with  differences  in 
intellectual  and  moral  capacity.  If  a  Bushman,  with  his  inferior 
type  of  brain,  were  placed  in  the  complex  circumstances  of  civil- 
ised life,  though  he  might  represent  a  high  gTade  of  development 
of  his  lower  type,  to  all  intents  and  purposes  he  would  be,  as 
Gratiolet  allows,  an  idiot,  and  would,  unless  otherwise  cared  for, 
inevitably  perish  in  the  severe  competition  for  existence.     AYere 


17G  PATHOLOGY  OF  MIND.  [chap. 

a  person  born  amongst  civilised  people  with  a  brain  of  no  higher 
order  than  the  natural  brain  of  the  Bushman,  in  consequence 
of  some  arrest  of  its  natural  development,  it  is  plain  that  he 
would  be  more  or  less  of  an  idiot ;  a  higher  type  of  brain, 
arrested  by  morbid  causes  at  a  low  grade  of  development,  is 
brought  to  the  level  of  a  lower  type  of  brain  which  has  reached 
its  full  development.  As  Von  Baer  long  ago  pointed  out,  the 
actual  position  of  a  particular  animal  in  the  scale  of  life  is 
determined,  not  by  the  type  alone,  nor  by  the  grade  of  develop- 
ment alone,  but  by  the  product  of  the  type  and  the  grade  of 
development. 

The  principal  varieties  of  defective  brain  met  with  cannot 
be  described  in  detail  here ;  suffice  it  to  say  that  all  sorts  and 
conditions  of  incomplete  growth  and  development  have  been 
observed  in  different  instances. 

There  are  idiots  of  the  microcephalic  type,  in  whom  an  arrest 
of  cerebral  development  has  taken  place,  and  a  palpably  defec- 
tive brain  is  met  with  in  consequence.  Malacarne  was  at  the 
pains  carefully  to  count  the  laminae  of  the  cerebellum  in  idiots 
and  in  men  of  intelligence,  and  he  found  them  to  be  less 
numerous  in  the  former  than  in  the  latter.  Now  these  laminte 
are  less  numerous  in  the  chimpanzee  and  the  orang  than  in 
man,  and  still  less  numerous  in  other  monkeys ;  so  far,  there- 
fore, there  is  an  approximation  in  some  idiots  to  the  simian 
type  of  brain.  Mr.  Paget  has  described  an  idiot's  brain  in 
which  there  had  been  a  complete  arrest  of  development  at  the 
fifth  month  of  foetal  life :  there  were  no  posterior  lobes,  the 
cerebellum  being  only  half  covered  by  the  cerebral  hemispheres, 
as  is  the  case  normally  in  many  of  the  lower  animals.  Dr.  Shut- 
tleworth  found  in  the  microcephalic  brain  of  an  imbecile  that 
although  the  frontal  and  parietal  lobes  were  fairly  developed 
the  temporo-sphenoidal  lobes  were  small  and  deficient  in  front,  and 
their  convolutions  and  fissures  incompletely  marked;  the  occipital 
lobes  were  quite  rudimentary,  exhibiting  no  fissures  and  convolu- 
tions, so  that  the  greater  part  of  the  cerebellum  was  uncovered.^ 
Gratiolet  found  in  the  brain  of  a  microcephalic  idiot,  aged 
seven,  the  under  surface  of  the  anterior  lobes  much  hollowed, 

^  Journal  of  Mental  Science^  October,  1878. 


v.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       177 

with  great  convexity  of  the  orbital  arches,  as  is  the  rule  in 
the  monkey.^ 

Mr.  Marshall  has  carefully  examined,  and  described  in 
an  elaborate  paper,  the  brains  of  two  idiots  of  European 
descent :  the  convolutions  were  fewer  in  number  than  in  the 
apes,  individually  less  complex,  broader,  and  smoother — "  In 
this  respect,"  he  observes,  "  the  idiots'  brains  are  even  more 
simple  than  the  brain  of  the  gibbon,  and  approach  that  of  the 
baboon  (Cynocephalus)  and  sapajou  (Ateles)."  ^  Though  he 
agrees  with  other  observers  that  the  condition  of  the  cerebra  in 
the  idiots  is  neither  the  result  of  atrophy  nor  of  a  mere  arrest 
of  growth,  but  consists  essentially  in  an  imperfect  evolution  of 
the  cerebral  hemispheres  or  their  parts,  dependent  on  an  arrest 
of  development,  he  points  out  the  strong  grounds  there  are  for 
inferring  that,  after  the  cessation  of  evolutional  changes,  the 
cerebra  experience  an  increase  of  size  generally,  or  a  mere 
growth  of  their  several  parts.  Consequently  the  cerebra  are 
much  larger  than  foetal  cerebra  in  which  the  convolutional 
development  is  at  a  similar  stage  ;  the  individual  convolutions 
themselves,  though  the  same  in  number,  are  necessarily  broader 
and  deeper ;  and  the  result  might  conceivably  be  a  brain  of  fair 
size  which  was  still  imperfectly  developed.  Many  more  in- 
stances have  been  recorded  of  idiots'  brains  in  which  there  w^as 
a  defect  of  convolutions  when  compared  with  a  normal  Cau- 
casian brain ;  the  principal  convolutions  being  more  simple  and 
symmetrical,  and  the  secondary  ones  sometimes  w^anting.  What- 
ever its  defects,  however,  an  idiot's  brain  never  resembles  a 
monkey's  exactly,  any  more  than  an  idiot  ever  resembles  exactly 
a  monkey  in  mind  :  it  is  not  a  complex  mechanism  brought  to 
the  condition  of  a  simpler  mechanism,  but  a  complex  mechanism 
imperfectly  constructed,  and  less  fit  for  its  purposes  therefore 
than  the  simpler  mechanism. 

ISTot  only  is  the  brain-weight  in  microcephalous  idiocy  very 
low  absolutely,  as  the  instructive  tables  of  Dr.  Thurnam  show, 
but  the  relative  amount  of  brain  to  body  is  "  extraordinarily  " 
diminished.     Thus  in  the  two  idiots  described  by  Mr.  Marshall 

^  Anatomie  Comparee  du  Systcme  Noi'veux. 
2  F]iilo60i)hical  Transactions,  loc.  cit. 


178  PATHOLOGY  OF  MIND.  [chap. 

the  proportion  of  brain  to  body  was  only  as  one  to  140  in 
the  female,  and  as  one  to  sixty-seven  in  the  male,  the  normal 
proportions  being  as  one  to  thirty-three  and  as  one  to  fourteen 
respectively. 

It  is  not  necessary  that  I  quote  more  authorities  to  prove 
that  small-headed  idiots  have  small  brains,  and  sometimes 
even  fewer  and  more  simple  convolutions  than  the  chim- 
panzee and  the  orang ;  that  man  made  a  morhid  kind  by  an 
arrest  of  development  may  be  brought  to  a  lower  level  than 
that  of  his  nearest  of  kin  among  animals.^  A  strict  examination 
of  the  stories  of  so-called  wild  men,  as  of  Peter  the  Wild  Boy  and 
of  the  young  savage  of  Aveyron,  has  proved  that  these  were  really 
cases  of  defective  organization — pathological  specimens.^  The 
interest  of  them  lies  in  this,  that  as  idiots  show  a  rude  re- 
version sometimes  towards  a  lower  type  of  brain  which  is 
natural  to  a  lower  animal,  so  in  their  habits  and  instincts  they 
sometimes  exhibit  evidence  of  a  reversion  to  the  fundamental 
instincts  of  animal  nature. 

In  some  idiots  and  imbeciles,  especially  those  of  the  Cretin 
type,  where  the  morbid  condition  is  endemic,  the  defect  seems 
to  depend  on  certain  morbid  changes  which  affect  primarily  the 
skull  rather  than  the  brain.  Injurious  influences,  affecting  the 
general  processes  of  the  bodily  nutrition,  prevent  the  normal 
growth  of  the  bones,  which  undergo  a  premature  ossification  of 
their  sutures ;  the  consequence  of  which  is  that  the  general 
expansion  of  the  skull,  which  should  take  place  as  the 
brain  grows,  is  prevented,  or  that  a  narrowing  of  the  slvull  is 
produced  at  the  part  where  this  happens.  Secondary  wide 
interference  with  the  development  of  other  parts  of  the  skull 
and  compensating  enlargements  in  other  directions  follow  the 
primary  evil  when  it  is  partial,  and  give  rise  to  cranial  deformi- 

^  Absence  or  defect  of  the  corpus  callosum  has  been  sometimes  met  with 
after  death,  but  seldom  ;  other  cerebral  deficiencies  will  commonly  coexist 
with  it ;  and  in  most  of  the  cases  of  this  sort  there  was  idiocy  or  some 
degree  of  mental  weakness  during  life.  Dr.  Julius  Sander  has  collected 
ten  cases,  which  api>ear  to  be  all  the  cases  hitherto  recorded  of  this  defect, 
and  described  them  in  Griesinger's  Archiv  fur  Psychiatrie  und  N erven- 
hranhlieiten^  b.  i.  1868. 

2  Observations  on  the  Deranged  Manifestations  of  the  Mind.  By  J.  S. 
Spurzheim,  M.D.     Also  Lectures  on  Man.     By  W.  Lawrence,  F.R.S, 


v.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       179 

ties  of  various  kinds.  It  is  common  to  observe  in  imbecile 
children,  especially  in  such  as  are  of  a  scrofulous  tempera- 
ment and  in  those  who  have  an  insane  inheritance,  a  very 
narrow  and  deeply  arched  palate,  which  is  described  as  saddle- 
shaped  ;  it  is  a  deformity  which  seems  to  be  connected  with  a 
defective  sfrowth  of  the  bones  at  the  base  of  the  skull :  and 
when  it  exists  without  actual  imbecility  it  usually  goes  along 
with  only  a  slender  understanding.  Of  necessity  the  natural 
growth  of  the  brain  is  hindered  by  those  morbid  changes ;  and 
it  is  no  wonder  that  the  deformed  head  is  accompanied  with  a 
torpid,  apathetic  character  and  with  great  mental  deficiency. 
However,  the  defects  of  brain  and  bone  may  be  concomitant 
effects.  As  the  evil  changes  are  commonly  not  manifest  until 
a  year  or  more  after  birth,  an  objection  might  well  be  made  to 
the  description  of  them  as  original  defects ;  but  whatever  the 
real  nature  of  the  deterioration  of  nutrition  which  is  at  the 
bottom  of  the  mischief,  whether  it  be  of  malarious  or  scrofulous 
nature,  it  admits  of  no  question  that  it  acts  upon  the  child 
through  the  mother  perniciously,  and  predetermines  its  defect. 

An  arrest  of  the  development  of  the  brain  occurring  soon  after 
birth  may  give  rise  to  idiocy  just  as  certainly  as  an  arrest  which 
has  taken  place  some  time  before  birth.  Specious  objection 
might  be  made  to  the  description  of  the  defect  as  original ;  but 
when  we  reflect  that  the  important  development  of  the  brain  as 
the  supreme  organ  of  the  conscious  life,  as  subserving  the  mental 
organization,  really  takes  place  after  birth,  we  may  admit  that 
a  defect  which  frustrates  development  is  practically  original, 
albeit  not  strictly  congenital.  There  are  not  a  few  idiots  in 
whom  the  brain  and  body  appear  to  be  well  formed,  while  the 
mental  development  remains  at  the  lowest  stage.  Epilepsy 
is  oftentimes  such  a  cause  of  idiocy,  but  it  k  not  possible  in 
all  cases  to  assign  a  definite  cause  of  the  arrest. 

In  some  instances  of  apparently  normal  brains  with  deficient 
intellect,  it  is  found  on  examination  that  the  ventricles  are 
more  or  less  dilated  and  contain  more  than  their  normal  quan- 
tity of  serous  fluid  ;  intermediate  conditions,  indeed,  are  met 
with  between  the  normal  state  in  this  respect  and  the  vastly 
dilated    ventricles    and    expanded  cerebral    substance   of    the 


180  PATHOLOGY  OF  MIND.  [chap. 

extremely  hydrocephalic  brain.  In  other  instances  where  the 
brain  looks  normal  to  the  naked  eye,  or  is  actually  hypertropliied, 
microscopic  examination  has  shown  that  its  normal  or  abnormal 
size  is  owing  not  to  the  natural  quantity  or  to  a  natural  increase 
of  its  proper  elements — namely,  the  nerve-cells  and  fibres, — 
but  to  an  abnormal  increase  of  the  connective  substance,  entail- 
ing perhaps  eventual  atrophy  of  them  and  their  capillaries.  In 
other  instances  the  pathologist  cannot  find  the  hidden  defect  in 
the  seemingly  perfect  organ  ;  nor  need  we  wonder  much  at 
that  when  we  reflect  that  most  important  intimate  physical  and 
chemical  changes  may  exist  without  being  detected  by  any 
means  of  research  that  we  are  j^et  in  possession  of.  There  is 
nothing  indeed  to  prevent  whole  territories  of  cells  in  the  cere- 
bral convolutions  being  wanting  without  the  pathologist  being 
able  to  find  it  out.  Lastly,  the  fault  may  lie  in  the  distribution, 
quality,  and  activity  of  the  blood  circulating  in  the  brain ;  the 
active  supply  of  good  blood  which  is  necessary  to  full  and  quick 
intelligence  being  prevented,  either  by  a  defective  quality  of  the 
blood  occurring  as  a  part  of  the  general  defective  nutrition,  or 
by  a  feeble  or  defective  heart,  which  is  not  very  uncommon 
in  idiocy. 

Other  idiotic  creatures  have  the  development  of  body  as  well 
as  mind  arrested.  The  extremest  cases  of  the  kind  are  those  in 
which  there  has  been  a  complete  cessation  of  growth  at  an  early 
period  of  childhood,  without  any  observable  deformity.  Dancel 
has  recorded  the  case  of  a  girl,  aged  twenty-four,  who  had  deve- 
loped normally  up  to  the  age  of  three  and  a  half  years,  after 
which  no  further  growth  took  place  until  she  reached  eighteen 
and  a  half  years,  her  bodily  and  mental  condition  being  that  of 
a  child  of  three  and  a  half  years  old.  At  twenty-one  she  in- 
creased a  little  more  in  size,  and  then  remained  unchanged  for 
the  rest  of  life.  Baillarger  exhibited,  in  May,  1857,  to  the  French 
Academy  of  Medicine,  a  young  woman  aged  twenty-seven,  who 
had  only  the' intelligence  and  inclinations  of  a  child  four  years 
old,  and  who  was  about  three  feet  high.  I  have  seen  a  some- 
what similar  instance  in  an  idiot  man.  Such  extreme  cases  are 
well  suited  to  excite  surprise  and  curiosity ;  they  are,  however, 
only  gross  results  of  a  deficiency  in  developmental  power  which 


V.J       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       181 

is  often  met  with  in  a  less  degree,  and  which  is  actually  wit- 
nessed in  every  degree.  The  truth  is,  that  every  element  of 
the  body  shares  usually  in  the  defective  vitality  of  idiocy.  In 
any  large  idiot  asylum  idiots  are  to  be  found  who,  without  any 
particular  deformity,  without  any  observable  disease  or  defective 
development  of  brain,  are  generally  sluggish  both  in  bodily  and 
mental  development ;  their  size  is  small ;  their  sexual  develop- 
ment takes  place  late  in  life,  or  perhaps  does  not  take  place 
at  all ;  their  circulation  is  languid,  and  their  sensibilities  are 
extremely  dull ;  their  movements  are  not  brisk,  but  feeble  and 
heavy,  and  sometimes  23artially  paralyzed ;  their  skin  gives  off 
an  offensive  odour ;  their  teeth  are  carious  and  soon  drop  out. 
In  mental  capacity  they  are  in  advance  of  the  true  idiots, 
for  they  can  learn  a  little,  are  capable  of  remembering,  and 
perhax^s  imitate  cleverly :  some  of  them  constitute  the  "  show- 
cases "  of  the  idiot  asylum  when  they  are  in  it ;  and,  when 
they  are  not,  they  may  become  difficult  cases  for  medico-legal 
inquiry,  if,  in  consequence  of  the  strength  of  their  passions 
and  of  their  deficiency  of  moral  power,  they  do  some  deed  of 
criminal  violence,  as  they  are  more  likely  to  do  after  puberty 
than  before  it.  All  the  concern  that  we  have  with  them  here  is  to 
draw  from  them  the  certain  conclusion  that  there  may,  by  reason 
of  unknown  conditions  affecting  nutrition,  be  every  degree  of 
imperfect  development  of  mind  and  body  down  to  actual  incapa- 
city to  develop  at  all ;  wherefore  imbecility  cannot  be  measured 
by  any  constant  standard,  but  must  always  be  a  matter  of  degree. 
The  causes  of  the  defective  cerebral  development  which  is  the 
physical  condition  of  idiocy  are  often  traceable  to  parents.  Fre- 
quent intermarriage  in  famihes  seems  in  some  cases  to  lead  to 
a  degeneration  which  manifests  itself  in  individuals  by  deaf- 
mutism,  albinoism,  and  idiocy.^  Parental  intemperance  and 
excess,  according  to  Dr.  Howe,  hold  high  places  as  causes  of 
convulsions,  idiocy,  and  imbecility  in  children;  out  of  300  idiots 
in  the  State  of  Massachusetts,  whose  histories  were  investigated  by 
him,  as  many  as  145  were  the  offspring  of  intemperate  parents.^ 

^  "On  Consanguineous  Marriages."      By  Arthur  Mitchell,  M.D. — Edin- 
hurgli  Medical  Journal,  1865. 

2  Re])ort  on  the  Causes  of  Idiocy  in  the  State  of  Massachusetts. 


182  PATHOLOGY  OF  MIND.  [chap. 

But  other  inquirers  who  have  been  at  the  pains  to  critically  test 
his  statistics  have  not  been  able  to  accept  so  high  a  proportion. 
It  is  not  doubted  that  the  parent  who  makes  himself  a  temporary- 
lunatic  or  idiot  by  his  degrading  vice  does  sometimes  propagate 
his  kind  in  procreation,  and  entail  on  his  children  the  curse  of  a 
hopeless  fate.  Many  remarkable  instances  have  been  recorded 
by  different  authors.  Guislain  mentions  a  family  of  maniacs 
born  of  a  woman  who  was  drunk  every  day.  In  the  Mechanics' 
Institution  at  Manchester  are  the  casts  of  the  small  heads  of 
seven  idiots  ;  their  father  was  a  desperate  drunkard,  and  as  he 
kept  a  public-house,  he  was  almost  always  drunk,  or  had  just 
been  so,  or  was  about  to  become  so.  Nothing  particular  was 
known  of  the  habits  of  his  wife.  They  had  eight  children,  the 
first  seven  of  whom,  who  were  the  idiots  in  question,  were  born 
while  the  father  was  under  the  influence  of  his  drunken  habits. 
Having  dissipated  his  property  he  had  no  longer  the  means  to 
get  drunk,  and  the  last  child,  a  daughter,  which  was  born  while 
he  was  sober  from  compulsion,  was  perfectly  sane,  and  was 
married  in  due  course.^  "  A  man,"  says  Marce,  "  who  had  several 
times,  in  consequence  of  excessive  drinking,  had  symptoms  of 
insanity,  married  twice  :  with  his  first  wife  he  had  sixteen  child- 
ren, fifteen  of  whom  died  within  a  year  of  convulsions;  the 
survivor  is  epileptic.  With  his  second  wife  he  had  eight 
children ;  seven  have  fallen  victims  to  convulsions,  and  the 
eighth  is  scrofulous."  ^  The  natural  term  of  insanity  proceeding 
unchecked  through  generations  is,  as  Morel  has  shown,  sterile 
idiocy.  When  man  frustrates  the  purposes  of  his  being,  and 
selfishly  ignores  the  laws  of  hereditary  transmission,  nature  takes 
the  matter  out  of  his  hands  and  puts  a  stop  to  the  propagation 
of  degeneracy.  Great  fright  or  other  mental  agitation  affecting 
the  mother  during  gestation,  or  irregularities  and  excesses  on 
her  part,  and  injury  to  the  child's  head  during  parturition,  may 
occasion  a  congenital  mental  defect  in  it.  But  many  of  the  causes 
of  idiocy  operate  after  birth  up  to  the  third  or  fourth  year. 
They  are  epilepsy,  the  acute  exanthemata,  perhaps  syphilis,  and 
certainly  starvation,  dirt,  and  overcrowding. 

1  Dr.  Noble,  Elements  of  Psychological  Medicine. 

2  Traite  Pratique  des  Maladies  Mentales.     Dr.  L.  V.  Marc^,  1862. 


v.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       183 

"When  there  are  no  sucli  signs  of  degeneracy  as  warrant  the 
suspicion  of  idiocy  or  imbecility,  there  is  still  large  room  for 
physical  causes  of  psychical  defect  which  we  cannot  detect.  The 
sensibility  of  nervous  structure,  whereby  an  impression  made 
at  one  point  is  almost  instantaneously  felt  at  any  distance,  is 
the  consequence  of  delicate,  active,  but  occult  movements  of 
its  molecules,  which,  like  thermal  oscillations  or  undulations  of 
light,  or  the  intimate  molecular  conditions  of  colour,  belong  to 
that  inner  life  of  nature  that  is  still  impenetrable  to  our  most 
delicate  means  of  investigation,  still  inaccessible  to  our  most 
subtile  inquiries.  Who  can  declare  the  nature  of  those  hidden 
molecular  activities  which  are  the  direct  causes  of  our  different 
tastes  and  smells  ?  Could  we  but  learn  what  these  intimate 
operations  essentially  are,  we  might  perhaps  attain  to  a  know- 
ledge of  the  intimate  constitution  of  bodies  which  we  hardly 
dream  of  now ;  indeed  it  seems  not  impossible  that  in  the  scien- 
tific cultivation  and  development  of  the  senses  of  taste  and 
smell,  as  the  eye,  the  ear,  and  the  touch  have  been  cultivated 
and  developed,  we  may  ultimately  gain  some  means  of  insight 
into  the  inner  recesses  of  nature. 

A  second  reason  why  there  may  be  numerous  and  serious 
defects  of  nervous  structure  which  cannot  yet  be  discovered 
is  based  upon  the  infinitely  complex  and  exquisitely  delicate 
structure  of  the  cortical  layers  of  the  hemispheres.  It  must 
be  confessed  that  many  physical  paths  of  nervous  function  in 
the  supreme  centres  may  be  actually  obliterated  without  our 
being  any  the  wiser,  for  it  was  only  yesterday,  so  to  speak. 
that  men  succeeded,  after  infinite  patient  research,  in  demon- 
strating a  direct  communication  between  the  different  nerve- 
cells,  and  between  nerve-fibres  and  cells.  The  obliteration 
of  such  a  physical  communication  in  the  supreme  centres 
might  plainly  render  impossible  a  certain  association  of  ideas, 
or  the  transference  of  the  activity  of  the  idea  to  an  out- 
going nerve-fibre — a  particular  function  and  expression  of 
mind.  The  convolutions  being  formed  of  several  delicate 
superimposed  layers,  it  is  natural  to  suspect  that  the  defective 
intelligence  of  idiocy  may  be  due  to  a  defective  development 
or  to  an  entire  absence  of  one  or  other  of  the  higher  of  these 
9 


184  PATHOLOGY  OF  MIND.  [chai-. 

layers,  wliicli  may  be  presumed  to  minister  to  the  more  abstract 
functions  of  mind. 

Thirdly,  it  must  be  admitted  that,  all  question  of  defect  of 
physical  structure  put  aside,  the  extremest  derangement  of  func- 
tion may  be  due  to  chemical  changes  in  the  complex  constitution 
of  nerve-element — changes  which,  in  the  present  state  of  know- 
ledge, are  still  less  discoverable  than  physical  changes.  Examine 
the  cells  of  a  man's  brain  at  the  end  of  a  day  of  great  mental 
activity,  and  at  the  beginning  of  a  day  after  a  good  night's 
rest ;  what  difference  would  be  detectable  ?  None  whatever ; 
yet  the  actual  difference  is  between  a  decomposition  and  a 
recomposition  of  nerve-element — between  a  capacity  and  an 
incapacity  of  function. 

It  is  beyond  question,  then,  that  there  may  be  modifications  of 
the  polar  molecules  of  nerve  element,  changes  in  its  chemical 
composition,  and  defects  in  the  physical  constitution  of  nervous 
centres,  which,  entirely  undetectable  by  tis,  do  nevertheless 
gravely  affect  function,  and  are  so  attested.  As  defective  sensi- 
bility and  motility  betray  defective  motor  and  sensory  centres, 
so  defective  intelligence  betokens  defective  mind-centres. 

This  is  a  conclusion'  which  ought  to  be  kept  well  in  mind 
when  we  are  tempted  to  speculate  concerning  the  unknown 
physical  conditions  of  an  inherited  predisjjosition  to  insanity. 
To  affirm  that  all  men  are  born  equal,  as  is  sometimes  heedlessly 
done,  is  to  make  as  untrue  a  proposition  as  it  is  possible  to 
make  in  so  many  words.  There  is  as  great  a  variety  of  minds 
as  there  observably  is  of  faces  and  of  voices  :  as  no  two  faces 
and  no  two  voices  are  exactly  alike,  so  are  no  two  minds  exact 
counterparts  of  one  another.  Each  person  presents  a  certain 
individuality,  characteristic  marks  of  features  and  disposition 
which  distii^guish  him  from  any  other  person  who  may  resemble 
him  ever  so  closely  ;  and  I  hold  it  to  be  true  that  every  special 
character  which  is  displayed  outwardly  is  represented  inwardly 
in  the  nerve-centres — that  it  is  the  outward  and  visible  sign  of 
an  inward  and  invisible  constitution  of  nerve-structure.  Men 
differ  greatly,  then,  both  in  original  capacity  and  in  quality  of 
brain :  there  is  a  continuity  of  intelligence  between  the  highest 
genius  and  the  lowest  stupidit}^  distinguished  men  being  raised^ 


v.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       185 

as  much  above  the  average  standard  of  ability  as  idiots  are  sunk 
below  it.  In  some  persons  there  is  the  potentiality  of  great  and 
varied  development,  whilst  in  others  there  is  the  innate  inca- 
pacity of  any  development.  There  are  manifest  differences 
in  the  fundamental  functions  of  reception  and  retention:  in 
some  the  mental  reaction  to  impressions  is  sluggish  and  in- 
complete, and,  without  being  idiots,  they  are  slow  at  perception 
and  stupid ;  in  others,  the  reaction,  though  not  quick,  is  very 
complete,  and  they  retain  ideas  firmly,  although  they  are  slow 
in  acquiring  them ;  in  some,  again,  the  reaction  is  rapid  and 
lively,  but  evanescent,  so  that,  though  quick  at  perception,  they 
retain  ideas  with  difficulty;  while  in  others  the  just  equili- 
brium between  the  internal  and  external  exists  by  which  the 
reaction  is  exactly  adequate  to  the  impression,  and  the  conse- 
quent assimilation  is  most  complete.  These  natural  differences 
in  the  taking  up  of  impressions  plainly  hold  good  also  of  the 
further  processes  of  digestion  and  combination  of  ideas,  which  in 
the  progress  of  mental  development  follow  upon  the  concrete 
perception.  It  is  easy  to  perceive  then  that  we  have,  as  original 
facts  of  nature,  every  kind  of  variation  in  the  quality  of  mind 
and  in  the  degree  of  reasoning  capacity,  and  that  it  is  as  gross  a 
mistake  to  endow  all  persons  with  a  certain  fixed  mental  poten- 
tiality of  uniform  character  as  it  would  be  to  endow  them  with 
the  potentiality  of  a  certain  fixed  bodily  stature. 

Viewed  on  its  physical  side,  as  it  rightly  should  be,  a  predis- 
position to  insanity  means  an  actual  defect  or  fault  of  some  kind 
in  the  constitution  or  composition  of  the  nerve  element  which 
functions  as  mind ;  there  is  an  instability  of  organic  composition, 
which  is  the  direct  result  of  certain  unfavourable  physical  ante- 
cedents. The  retrograde  metamorphosis  of  mind,  manifest  in 
the  different  kinds  of  insanity,  and  proceeding  as  far  as  actual 
extinction  in  extreme  dementia,  is  the  further  physical  conse- 
quence of  the  hidden  defect.  I  have  insisted  much  that  the 
physical  structure  of  the  mental  organization  embodies  in  its 
nature  and  gives  out  in  its  function  the  kind  of  activity  which 
determined  its  formation,  and  I  desire  now  to  have  it  particu- 
larly noticed  that  the  defective  nerve-structure  of  an  insane 
predisposition  is  an  example  of  this  truth.     It  owes  its  unstable 


186  PATHOLOGY  OF  MIND.  [chap. 

nature  to  the  unstable  and  ill-regulated  conduct  of  parents  or 
other  ancestors ;  being  the  materialization  of  past,  it  is  the 
potentiality  of  future,  irregularities.  It  is  easy  to  point,  on  the 
one  hand,  to  the  nervous  substance  of  the  infertile  idiot's  brain, 
and  on  the  other  hand,  to  that  of  the  philosopher's,  and  to  main- 
tain that  the  kind  of  nerve- structure  of  which  they  are  con- 
stituted is  the  same,  as  it  certainly  appears  to  be ;  but  so  long 
as  we  have  no  exact  knowledge  of  the  constitution  of  nerve- 
element  such  an  assertion  is  an  unwarrantable  assumption, 
and,  while  the  functional  effects  are  so  vastly  different  in  the 
two  cases,  there  are  valid  reasons  to  contradict  it. 

The  conclusion,  then,  which  we  have  reached  is,  that  an  indi- 
vidual, who,  by  reason  of  a  bad  descent,  is  born  with  a  predis- 
position to  insanity  has  a  native  nervous  constitution  which, 
wdiatever  name  may  be  given  to  it,  is  unstable  or  defective, 
rendering  him  unequal  to   bear   the   severe  stress  of  adverse 
events.     In  other  words,  the  man  has  what  I  have  called  the 
insane  temperament.     Were  it  thought  fitting  to  give  a  name  to 
this  temperament  or  diathesis,  as  in  algebra  we  use  a  letter  to 
represent  an  unknown  quantity,  it  might  properly  be  described 
as  the  Diathesis  spasmodica  or  the  Neurosis  spasmoclica  :  such 
names  expressing  very  well  an  essential  character  of  the  tem- 
perament— that  is,  the  want  of  equilibrium  between  the  different 
nervous  centres,  their  tendency  to  in-coordinate  and  disruptive 
action.    There  is  some  inherent  instability  of  nervous  element 
whereby  the  mutual  reaction  of  the  nerve-centres  in  the  higher 
walks  of  nervous  function  does  not  take  place  properly,  and  due 
consent  or  co-ordination  of  function  is  replaced    by  irregular 
and  purposeless  independent  action.     The  person  is  prone  under 
all  circumstances  to  strange  or  whimsical  cranks  of  thought  and 
caprices  of  feeling,  or  to  eccentric  or  extravagant  acts,  and  likely 
under  the  pressure  of  extraordinary  circumstances  to  suffer  an 
entire  overthrow  of  his  mental  equilibrium :  there  is,  as  it  were, 
a  loss  of  the  power  of  self-control  in  the  nerve-centres,  an  inca- 
.  pacity  of  calm,  self-contained  activity,  subordinate  or  co-ordinate, 
and  energy  is  dissipated  in  explosive  discharge,  which,  like  the 
impulsive  action  of  the  passionate  man,  surely  denotes  an  irrit- 
able weakness.   For  here,  as  elsewhere,  co-ordination  of  function 


v.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       187 

signifies  power,  innate  or  acquired,  and  marl^s  exaltation  of 
organic  development ;  self-restraint  being  a  higher  power  than 
self-abandonment. 

Is  it  not  plain  how  impossible  it  is  to  do  full  justice  to  any 
individual,  sane  or  insane,  by  considering  him  as  an  isolated 
fact?  Beneath  his  conscious  activity  and  reflection  there  lies 
the  unconscious  inborn  nature  which  all  unawares  mingles  con- 
tinually in  the  events  of  life — the  spontaneity  w^hence  spring 
the  sources  of  desire  and  the  impulses  of  action ;  for  the  con- 
scious and  the  unconscious,  like  w^arp  and  w^oof,  together  con- 
stitute the  texture  of  life.  ISTo  one,  be  he  ever  so  patient  and 
apt  in  dissimulation  or  crafty  in  reticence,  can  conceal  or  mis- 
represent himself  always ;  in  spite  of  consummate  art  his  real 
nature  reveals  itself  constantly  by  slight  and  passing  signs,  of 
which  he  is  himself  unaware,  in  the  movements  of  the  part 
which  he  plays,  and  bursts  out  of  the  restraints  of  hypocrisy 
in  the  most  earnest  pulsations  of  his  life.  The  inborn  nature 
constitutes  the  foundation  upon  wliich  all  the  acquisitions  of 
development  must  rest ;  it  is  the  substratum  in  which  all  con- 
scious mental  phenomena  are  rooted.  When  it  is  defective 
radically,  no  systematic  labour  wall  avail  to  counterbalance 
entirely  the  defect :  if  the  attempt  be  made  to  build  the  super- 
structure of  a  large,  vigorous,  and  complete  culture  upon  the 
rotten  foundations  which  an  inherited  taint  of  nerve  element 
implies,  something  will  be  w^anting ;  some  crack  in  the  building 
will  betray  the  instability  of  the  foundations,  even  when  the 
w-hole  structure  does  not  fall  "in  ruin  hurled."  Any  mental 
philosophy  which  takes  not  notice  of  the  foundations  of  the 
character,  but  ignores  the  important  differences  of  individual 
nature,  does  not  truly  reflect  the  facts,  and  must  be  provisional 
and  transitory.  It  is  guilty  of  the  same  error  as  that  into  which 
an  introspective  psychology  falls  w^hen,  isolating  the  particular 
state  of  mind,  and  neglecting  the  antecedent  conditions  upon 
which  it  has  followed,  it  pronounces  the  wiU  to  be  free;  by 
isolating  the  individual,  and  forgettmg  that  he  is  but  a  link  in 
the  long  chain  of  nature's  organic  evolution,  it  transforms  him 
into  an  abstract  and  impossible  entity,  and  often  judges  his 
actions  with  an  unjust  judgment. 


188  PATHOLOGY  OF  MIND.  [chap. 

Here  I  liave  the  misfortune  to  be  in  seeming  contradiction 
with  so  sound  and  sober  a  thinker  as  Locke,  who,  admitting 
natural  faculties  to  be  great  gifts,  declares  acquired  habits  to  be 
of  more  value,  and  many  excellences  which  are  looked  upon  as 
natural  endowments  to  be,  when  examined  into  more  narrowly, 
the  product  of  exercise.  "  Defects  and  weaknesses  in  men's  un- 
derstandings," he  says,  "  come  from  a  want  of  right  use  of  their 
minds.  There  is  often  a  complaint  of  want  of  parts,  when  the 
fault  lies  in  a  want  of  a  due  improvement  of  them."  No  doubt 
that  is  so ;  at  the  same  time  it  is  certain  that  there  is  often- 
times a  want  of  parts  which  no  training  will  make  good,  and 
tlxat  the  hope  of  training  rests  upon  a  possession  of  the  ordinary 
gifts  of  nature.  If  a  man's  nature  have  a  radical  flaw  in  it,  he 
can  no  more  get  entirely  rid  of  it  by  training  than  the  idiot, 
whose  want  of  parts  is  incontestable,  can  raise  his  intelligence 
to  the  average  level  by  much  study,  or  than  a  short  man  can,  by 
taking  thought,  add  one  cubit  to  his  stature.  Acquired  habits 
may  do  much  to  compensate  natural  deficiencies,  but  the  mis- 
fortune is  that  the  deficiency  often  shows  itself  in  a  constitutional 
inability  to  acquire  ihe  habit.  Moreover,  superior  excellences 
of  parts  can  only  be  built  upon  corresponding  foundations. 

2.  Quantity,  Quality,  and  Distribution  of  the  Blood. — The  grey 
centres  of  the  brain,  and  the  cortical  layers  of  the  hemispheres 
especially,  are  richly  supplied  with  blood-vessels,  even  when 
comparison  is  made  with  the  notably  abundant  supply  of  the 
spinal  centres ;  fully  one-fifth  of  the  whole  quantity  of  the 
blood  in  the  body  going  to  the  head.  The  ideational  centres 
need  for  the  due  exercise  of  their  functions  a  rapid  renewal  of 
arterial  blood,  an  active  interchange  of  some  kind  continually 
going  on  between  it  and  their  elements ;  indeed,  as  I  have  pre- 
viously argued,  the  life  of  a  nerve-cell  may  be  looked  upon  as  a 
continual  metastasis,  its  substance  being  decomposed  during 
function  and  recompounded  during  rest,  and  the  blood  being  the 
agent  that  brings  what  is  w^anted  for  repair  and  carries  away 
what  is  effete  after  function.  The  quantity  and  quality  of  the 
blood,  therefore,  circulating  through  the  supreme  centres,  must 
affect  their  functions  in  an  important  manner,  as  will  appear 
more  clearly  when  it  is  considered  that  they  are  the  most  sensi- 


v.]         THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       189 

tive  elements  of  the  body  in  this  regard.  When  the  most  expert 
chemist  is  unable  to  detect  anything  unusual  in  tlie  atmosphere 
of  a  room  in  wliich  many  people  are  met  together,  a  dehcate 
woman  may  get  a  headache  and  actually  faint  away.  If  a  mix- 
ture of  air  and  carbonic  acid  in  certain  proportions  be  inspired 
like  chloroform,  it  will,  like  it,  act  as  an  anaesthetic,  paralyzing 
consciousness ;  and  if  the  blood  be  charged  with  a  stronger  dose 
of  the  gas,  the  nerve-elements  are  stifled  outright. 

"When  there  is  a  rapid  flow  of  healthy  blood  through  the 
supreme  cerebral  centres,  a  quick  interchange  goes  on  between  it 
and  the  nerve-cells,  and  the  excitation  and  interaction  of  ideas 
proceed  with  vivacity.  The  effect  of  active  thought  is  to  produce 
such  a  determination  of  blood,  which  in  turn  is  the  necessary 
condition  of  the  continuance  of  the  active  function.  But  when 
a  natural  determination  of  blood  degenerates  into  a  greater  or 
less  stasis  or  congestion,  as  it  may  easily  do  wdien  intellectual 
activity  is  too  much  prolonged,  or  when  congestion  is  other- 
wise produced,  then  there  is  an  inability  to  think ;  torpor  and 
confusion  of  thought,  depression  and  irritability,  swimming  in  the 
head,  disturbance  of  sight  and  of  hearing,  delirium  and  convul- 
sions in  the  worst  event,  testify  to  a  morbid  condition  of  things. 
It  is  striking  how  completely  a  slight  congestion  of  the  brain 
will  incapacitate  a  person  for  mental  activity,  and  how  entirely 
the  strong  man  is  prostrated  thereby :  an  afflicting  stagnation  of 
ideas  accompanies  the  stagnation  of  blood ;  and  he,  heretofore 
so  strong  and  self-confident,  realizes  in  vivid  affright  on  how 
sliojht  a  thread  hanc^s  the  whole  fabric  of  his  intellect.  If  the 
morbid  state  should,  instead  of  remaining  passive,  or  passing 
aw^ay  altogether,  become  active,  as  it  does  when  actual  inflam- 
mation occurs,  then  the  function  of  the  cerebral  centres  becomes 
irregular  and  degenerate ;  co-ordination  is  lost,  as  it  is  in  the 
spinal  cord  under  like  circumstances,  and  a  wild  and  incoherent 
delirium  attests  the  independent  and,  if  I  might  so  speak,  con- 
vulsive action  of  the  different  cells :  the  delirious  ideas  are  the 
expression  of  a  condition  of  things  in  the  supreme  centres  w^hich 
is  the  counterpart  of  that  which  in  motor  centres  utters  itself 
in  spasmodic  movements  or  convulsions.  The  destruction  of 
co-ordination  of  function  is  the  abolition  of  volition  ;   and  such 


190  PATHOLOGY  OF  MIND.  [chap. 

purposeless  or  dangerous  acts  as  the  delirious  being  performs  are 
dictated  by  the  morbid  ideas  that  are  excited  by  the  abnormal 
physical  condition.  Some  writers  have  thoughtlessly  spoken  of 
this  degenerate  activity  in  its  earlier  stages  as  increased  mental 
activity,  as  they  have  also  spoken  of  active  inflammation  as 
increased  vital  action;  not  otherwise  than  as  if  convulsions 
were  accounted  signs  of  strength,  or  as  if  the  tale  of  an  idiot, 
because  it  is  full  of  sound  and  fury,  though  signifying  nothing, 
were  the  index  of  high  mental  activity. 

Dr.  Mason  Cox  pointed  out  long  ago  that  the  pulses  in  the 
radial  and  carotid  arteries  sometimes  differed  from  one  another 
in  the  insane,  being  soft  and  weak  in  the  former — for  it  is  seldom 
much  affected  at  the  wrist  even  in  active  madness — when  it  was 
full  and  hard  in  the  latter;  and  Dr.  Burrows,  who  also  called 
attention  to  irregularities  and  discrepancies  in  arterial  pulsa- 
tion, took  notice  that  the  carotids  might  differ  from  each  other, 
and  both  or  either  of  them  from  other  arteries.  Of  no  small 
interest,  in  relation  to  the  influence  of  the  supply  of  blood  to  the 
brain,  are  the  vigour  and  revival  of  function  that  are  sometimes 
imparted  by  an  attack  of  fever  to  brain  enfeebled  by  chronic 
insanity ;  patients  in  even  advanced  state  of  disease  may  be- 
come quite  rational  for  a  time  during  fever,  and  relapse  after 
its  subsidence  ;  .  or  a  demented  patient,  who  usually  exhibits  no 
spark  of  intelligence,  may  quicken  into  a  certain  mental  activity.^ 

1  Examples  of  such  temporary  revival  of  cerebral  functions  during 
fever  have  been  related  by  various  authors,  and  are  well  known  to  pliysi- 
cians  who  have  much  to  do  with  the  insane.  The  following  may  suffice 
here  : — "The  following  case,  related  to  me  by  a  medical  friend,  will  serve 
to  show  that  even  in  idiocy  the  mind  may  be  rather  suppressed  than 
destroyed.  A  young  woman,  who  was  employed  as  a  domestic  servant  by 
the  father  of  the  relater  when  he  was  a  boy,  became  insane,  and  at  length 
sank  into  a  state  of  perfect  idiocy  (dementia).  In  this  condition  she 
remained  for  many  years,  when  she  was  attacked  by  a  tj^phus  fever  ;  and 
my  friend,  having  then  practised  some  time,  attended  her.  He  was  sur- 
prised to  observe,  as  the  fever  advanced,  a  development  of  the  mental 
powers.  During  that  period  of  the  fever  when  others  are  delirious,  this 
patient  was  entirely  rational.  She  recognized,  in  the  face  of  her  medical 
attendant,  the  son  of  her  old  master  whom  she  had  known  so  many  years 
before  ;  and  she  related  many  circumstances  respecting  the  family,  and 
others  which  had  happened  to  herself  in  her  earlier  days.  But,  alas  !  it 
was  only  the  gleam  of  reason  ;  as  the  fever  abated,  clouds  again  enveloped 
the  mind  ;  she  sank  into  her  former  deplorable  state,  and  remained  in  it 


v.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       191 

Several  cases  have  been  recorded  in  wliich  actual  recovery  from 
insanity  has  followed  an  intercurrent  attack  of  typhoid  fever, 
scarlatina,  and  variola ;  but  the  rule  certainly  is  that  the  ame- 
lioration or  modification  of  the  mental  state  which  commonly 
occurs  during  the  fever  passes  away  as  the  fever  subsides.  It 
may  be  presumed  that  the  excitement  and  the  quickened  circu- 
lation of  the  brain  either  stimulate  the  indolent  and  exhausted 
nerve-cells  in  which  force  is  generated,  or  open  up  obstructed 
paths  of  association,  not  otherwise  than  as  the  stimulus  of  alcohol 
stirs  up  forgotten  ideas  in  a  healthy  brain  and  quickens  their 
associations.  If  this  be  so,  it  is  an  interesting  proof  that  the 
nerve-cells  and  the  paths  of  normal  association  are  not  so 
damaged  or  broken  up  as  to  be  beyond  restoration  even  in  ad- 
vanced madness  ;  the  former  are  deadened  and  the  latter  blocked, 
as  it  were,  but  the  continuity  of  structure  is  preser^^ed  ;  and 
both  are  capable  of  doing  their  proper  work  again  when  reani- 
mated by  a  strong  stimulus  of  a  suitable  kind. 

Since  the  time  of  Hippocrates  it  has  been  known  that  when 
there  is  too  little  blood  in  the  brain  symptoms  are  exhibited  very 
like  those  which  are  produced  by  a  congestion  of  blood :  pain  and 
swimming  in  the  head,  mental  torpor  and  confusion  of  thought, 
affections  of  the  senses  and  of  movement,  and  in  extreme  cases 
convulsions  and  delirium,  occur  in  consequence  of  anaemia  of  the 
brain  as  certainly  as  they  do  in  consequence  of  congestion.  In 
both  cases  the  due  nutrition  of  the  nerve-cell,  which  is  the  agent 
of  cerebral  function,  is  greatly  hindered ;  and  much  of  the  ill 
effect  is  similar,  though  the  cause  appears  to  be  so  different. 
The  intimate  causes  are  not  so  different  as  they  seem,  w^hen  we 
proceed  to  analyze  the  conditions  comprised  under  the  terms 
ansemia  and  congestion.  In  that  unceasing  active  relation  '"^ 
between  the  organic  element  and  the  blood  by  which  the  due 
reparative  material  is  brought  and  waste  matter  carried  away, 
It  amounts  to  much  the  same  thing  whether,  through  congestive 
stasis  of  the  blood,  the  refuse  is  not  carried  off  and  reparative 
material  brought  to  the  spot  where  it  is  wanted,  or  whether  a 

until  her  death,  wliich  happened  a  few  years  afterwards." — Descrijption  of 
the  Retreat  near  YorJc,  p.  137.  By  Samuel  Tuke.  1813.  See  also  Journal 
of  Mental  Science,  July,  1872. 


192  PATHOLOGY  OF  MIND.  [chap. 

like  result  ensues  by  reason  of  a  defective  blood  and  deficient 
circulation :  it  is  little  matter  to  the  inhabitants  whether  the 
street  is  blocked,  or  whether  its  entrance  is  closed,  so  long  as 
free  circulation  is  prevented. 

If  the  carotid  arteries  of  a  dog  be  tied,  and  pressure  be  then 
made  on  its  vertebral  arteries,  as  was  done  by  Sir  A.  Cooper, 
the  functions  of  the  brain  are  entirely  suspended ;  the  animal 
falls  into  a  deep  coma,  its  respiration  ceases  in  a  few  moments, 
and  it  appears  to  be  dead ;  but  if  the  pressure  be  removed  from 
the  vertebral  arteries,  the  manifestations  of  life  reappear,  and 
the  animal  regains  rapidly  the  integrity  of  its  cerebral  functions. 

/  In  like  manner  sleep  may  be  produced  in  the  human  subject  by 
strong  pressure  upon  the  carotid  arteries  in  the  neck ;  and  if  we 
may  believe  the  authority  of  an  old  writer  on  insanity,  such 
pressure  has,  while  it  was  continued,  actually  suspended  mental 
excitement  sometimes,  and  restored  intelligence.  In  melan- 
cholia and  in  dementia  the  languid  circulation  in  the  cold  and 
livid  hands  and  almost  insensible  skin  is  very  notable ;  and  it 
is  plain  that  if  the  cerebral  circulation  is  in  anything  like  the 
same  relaxed  and  feeble  state  there  is  quite  enough  to  account 
for  the  mental  symptoms.  The  wanderings  of  mind  just  before 
going  to  sleep,  the  delirium  which  breaks  out  sometimes  as 
convalescence  from  fever  sets  in,  the  distress  of  the  melancholic 
patient  when  he  wakes  in  the  morning,  are  perhaps  due  in  part 
to  a  diminution  of  the  proper  blood-supply  to  the  brain.  It 
should  be  noted  that  an  irregularity  in  the  blood-supply  with 
consequent  derangement  of  nutritive  action  will  lead  to  a  con- 
dition of  brain  comparable  with  what  we  call  irritation  in  other 
organs  ;  falling  short  of  actual  inflammation,  it  is  marked  by 
an  undue  impressionability,  a  diminution  of  proper  functional 
energy,  a  ready  excitability  to  action  of  a  perverted  kind ;  and 
it  is  the  exact  counterpart  in  the  highest  centres  of  a  similar 
condition  in  the  sensory  and  motor  centres  which,  similarly 
caused,  shows  itself  in  those  perversions  of  sensation  and  motion 

x  which  are  classified  as  hypersesthesia  and  hyperkinesia. 

Temporary  irregularities  in  the  supply  of  blood  to  the 
supreme  nervous  centres  may,  and  often  do,  pass  away  without 
leaving  any  ill  consequences  behind  them  ;  but  when  they  recur 


v.]       THE  CAUSATION  AND  PREVENTION  OF  INSANITY.        193 

frequently,  and  become  more  lasting,  their  disappearance  is  by 
no  means  the  disappearance  of  the  entire  evil :  the  effect  has 
become  a  cause  which  continues  in  action  after  the  original  cause 
has  been  removed ;  and  permanent  mental  disorder  may  be  thus 
established.  Once  the  habit  of  morbid  action  is  fixed  in  a  part, 
'it  continues  as  naturally  as,  under  better  auspices,  the  normal 
physiological  action.  It  is  always,  therefore,  of  great  import- 
ance to  give  timely  heed  to  the  earliest  warning  of  its  presence 
which  morbid  action  gives ;  but  it  is  of  paramount  import- 
ance to  do  so  in  the  case  of  organic  element  so  exceedingly 
susceptible  and  so  exquisitely  delicate  as  nerve  element. 

It  is  a  question  whether  one  has  not  to  do  with  local  rather 
than  with  general  irregularities  of  the  circulation  in  most  cases 
of  mental  derangement  in  which   there   is  reason   to   suspect 
vascular  disturbance.     So  little  do  we  yet  know  exactly  of  the 
intimate  physiology  of  the  vaso-motor  system  that  we  can  only 
guess  at  the  precise  character  and  mechanism  of  these  local 
irregularities ;  but  we  know  enough  to  be  sure  of  a  wide-reach- 
ing and  important   function  of  the  vaso-motor    system  in  the 
economy.  Mental  causes  may  no  doubt  occasion  them  ;  it  is  pro- 
bable that  all  active  emotions  are  accompanied  by  changes  in 
.the  circulation  through   vaso-motor  inhibition,  and  that  such 
vascular  disturbances  may  be  produced  by  them  within  the 
brain  very  mucli  as  blushing  is  produced  over  the  face  and  neck 
by  shame,  or  as  relaxation  of  the  sphincters  is  sometimes  caused 
by  fear.     Then  again  circulation-disturbances  within  the  brain 
will  react  upon  the  innervation-centres  of  the  heart  and  large 
vessels  within  the  medulla  oblongata,  and  so  affect  the  pulse 
secondarily :  in  melancholia,  for  instance,  we  sometimes  notice 
a  slow,  irregular,  and  intermittent  pulse,  while  the  patient  is 
depressed  and  anxious  and  apprehensive,  whicb  becomes  full 
and  regular  so  soon  as  the  anxiety  and  apprehension  pass  off. 
Severe  primary  disease  of  the   brain  probably  acts   upon  the 
pulse  through  the  same  mechanism;  for  a  pulse  of  about  sixty- 
eight,  quick  and  jerky,  not  actually  intermittent,  but  irreg-ular, 
being  now  faster  and  now  slower,  without  any  evident  regularity 
in  its   irregularities,  is  thought  to  warrant   a   strong  suspicion 
of  the  existence  of  such  disease.      Abdominal  disturbances  will 


194  PATHOLOGY  OF  MIND.  [chap. 

also  gravely  affect  the  cerebral  vaso-motor  centres  ;  in  relation  to 
which   an   experiment  by   Goltz   is   instructive.      On   tapping 
sharply  on  the  abdomen  of  a  frog  the  heart  and  vessels  of  which 
he  had  previously  exposed,  he  found  that  after  a  tap  or  two  the 
heart  stopped,  beginning  to  beat  again  after  a  short  pause.     At 
the   same   time   the   abdominal   vessels,   especially   the   veins, 
dilated  widely.     The  tapping  irritates  the  mesenteric  nerves ; 
the  impression  is  transmitted  by  them  to  the  inhibitory  centres 
in  the  medulla;  and  the  consequence  is,  first,  inhibition  of  the 
heart,  and,  secondly,  of  the  vaso-motor  centres  of  the  intestinal 
vessels.     What  is  to  hinder  disorder   of  an   abdominal   organ 
from  producing  in  like  manner  a  local  circulation- disturbance 
within  the  brain  ?   We  know  it  will  produce  a  condition  favour- 
able to  certain  emotional  moods,  and  we  suspect  such  moods 
to  be  accompanied  by  vascular  changes.     The  more  closely  we 
look,  the  more  clearly  it  appears  that  the   phenomena   of  the 
whole  mental  and  bodily  economy  form  one  circle  of  operations, 
essentially  interworking,  and  ever  coming  back  upon  one  another. 
A  vitiated  blood  quickly  affects  the  function  of  the  supreme 
cerebral  centres.     Alcohol  yields  the  simplest  instance  in  illus- 
tration of  the  disturbing  action  on  mind  of  a  foreign  matter 
introduced  into  the  blood  from  without :  here,  where  each  phase 
of  an   artificially   produced    insanity   is    passed   through   suc- 
cessively in  a  brief  space  of  time,  we  have  the  abstract  and  brief 
chronicle  of  the  history  of  insanity.     Its  first  effect  is  to  pro- 
duce  an   agreeable  excitement,  a  lively   flow   of  ideas,  and  a 
general  activity  of  mind — a  condition  not  unlike  that  which 
oftentimes  precedes  an  attack  of  mania;  then  there  follow,  as 
in  insanity,  sensory  and  motor  troubles  and  the  automatic  exci- 
tation of  ideas  which  start  up  and  follow  one  another  without 
order,  so  that  more  or  less  incoherence  of  thought  and  speech  is 
exhibited,   while  at  the  same  time  passion   is   easily   excited, 
which  takes  different  forms  according  to  the  individual  tempera- 
ment ;  after  this  stage  has  lasted  for  a  time — in  some  longer,  in 
others  shorter — it  passes  into  depression  and  maudlin  melancholy, 
as  convulsion  passes  into  paralysis ;  the  last  scene  of  all  being 
one   of  dementia  and  stupor.     The  different  phases  of  mental 
disorder  are  compressed  into  a  short  period  of  time  because  the 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       195 

action  of  the  poison  is  quick  and  transitory  ;  but  we  have  only 
to  spread  the  poisonous  action  over  years,  as  the  regular 
drunkard  does,  and  we  get  a  chronic  and  enduring  insanity  in 
which  the  foregoing  scenes  are  more  slowly  acted.  Or,  if  death, 
cutting  short  the  career  of  the  individual,  puts  a  stop  to  the 
lull  development  of  the  tragedy  in  his  life,  we  may  still  have  it 
played  out  in  the  lives  of  his  descendants ;  since  the  drunkenness 
of  the  parent  sometimes  becomes  the  insanity  of  the  offspring, 
which  thereupon,  if  not  interfered  with,  goes  through  the  down- 
ward course  of  degeneracy  described.  It  is  worth  while  to  take 
note  by  the  way  how  differently  alcohol  affects  different  people 
according  to  their  temperaments,  ever  bringing  forward  the 
unconscious  real  nature  of  the  person  :  one  it  makes  a  furious 
maniac  for  the  time  being;  another  it  makes  maudlin  and 
melancholic;  and  a  third  under  its  influence  is  stupid  and 
heavy  from  the  beginning.  So  it  is  with  insanity  otherwise 
caused :  the  individual  constitution  or  temperament,  rather  than 
the  exciting  cause  of  the  disease,  determines  the  form  which  the 
madness  takes.  An  exact  differential  pathology  would  involve 
the  vastly  difficult  knowledge  of  what  constitutes  individual 
temperament. 

Other  poisons  besides  alcohol,  such  as  opium,  belladonna, 
Indian  hemp,  stimulate  and  ultimately  derange  the  function  of 
the  supreme  cerebral  centres.  It  is  interesting  to  notice  that  the 
different  nervous  centres  of  the  body  evince  elective  affinities 
for  particular  poisons  :  while  the  spinal  motor  centres  have  a 
special  affinity  for  strychnine,  the  cerebral  centres  seem  to  be 
untouched  by  it ;  belladonna,  on  the  other  hand,  rather  depresses 
spinal  activity,  but  acts  powerfully  upon  the  centres  of  con- 
sciousness, giving  rise,  at  an  early  period  of  its  action,  to 
delirium  characterized  by  hallucinations  and  illusions  ;  and 
Indian  hemp  seems  to  act  mainly  on  the  sensory  centres, 
exciting  remarkable  hallucinations.  That  medicinal  substances 
do  display  these  elective  affinities  is  a  proof,  at  any  rate,  that 
there  are  important  intimate  differences  in  the  constitution  or 
composition  of  the  different  nervous  centres,  notwithstanding 
that  we  are  unable  to  detect  the  nature  of  them  ;  and  it  may 
be  we  have  in  these  different  effects  of  poisons  on  the  nervous 


196  PATHOLOGY  OF  MIND.  [chap. 

S3^stem  the  promise  of  a  useful  means  of  investigation  into  the 
constitution  of  the  latter.  Albeit  the  rapid  recovery  which 
takes  place  from  the  effects  of  these  poisons  proves  that  the 
combinations  which  they  form  with  nerve  element  are  tem- 
porary, it  must  be  borne  in  mind  with  regard  to  them,  as  with 
regard  to  alcohol,  that  the  nervous  system,  when  repeatedly 
exposed  to  their  poisonous  influence,  acquires  a  disposition  to 
irregular  or  morbid  function,  even  when  they  are  not  present ; 
so  that  more  or  less  marked  mental  disorder  ensues  sometimes 
from  their  continued  abuse :  they  are  efficient  to  initiate  a  de- 
generacy which  then  goes  on  of  itself.  The  paralysis  produced 
by  lead  and  mercury  in  workmen  who  have  been  long  exposed 
to  their  poisonous  effects,  and  the  utter  mental  prostration  and 
fatuity  that  are  witnessed  in  the  worst  cases,  are  further  proofs 
of  the  injurious  action  upon  nerve-centres  of  poisons  that  may 
be  detected  in,  and  extracted  from,  the  tissues. 

But  the  condition  of  the  blood  may  be  vitiated  by  reason  of 

something  bred  in  it,  or  by  reason  of  the  retention  in  it  of  some 

substance  which  should  rightly  be  excreted  from  it.     Without 

any   change  whatsoever  having  taken  place   in  his   external 

relations,  the  presence  of  bile  in  his  blood  shall  drive  a  person 

to  regard  his  surroundings  and  his  future  in  the  gloomiest  light 

imaginable  ;  he  may  know  that  a  few  hours  ago  things  looked 

quite  otherwise,  and  may  believe  that  in  a  few  hours  more  thoy 

will  again  have  a  different  aspect,  yet  for  the  time  being  he  is 

a  victim  of- a  humour  which  he  cannot  withstand.     Philosophy 

is  of  little  avail  to  him ;   for  philosophy  cannot  rid  him  of  that 

condition  of   nervous    element   which   the   impure   blood  has 

engendered,  and  which  is  the  occasion   of  his  gloomy  feelings 

and  painful  conceptions.     Carry  this  morbid  state  of  nervous 

element  to  a  further  stage  of  depression  and  make  it  last,  there 

ensues  the  genuine  melancholia  of  insanity.    In  like  manner  the 

presence  of  some  product  of  incomplete  nutrition  in  the  blood 

of  a  gouty  patient  gives  rise  to  an  irritability  of  temper  which 

no  strain  of  mental  control  can  remove,  though  it  may  succeed 

sometimes  in  suppressing  its  manifestations.     The  mental  tone 

being,  as  already  set  forth,  the  expression  of  a  physical  condition 

of  nervous  element,  is  sometimes  beyond  conscious  management. 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      197 

just  as  the  delirium  and  convulsions  of  tlie  patient  dying  from 
uraemic  poisoning  are  beyond  control.  All  writers  on  gout  are 
a^^reed  that  a  suppressed  gout  will  produce  severe  mental  dis- 
order, and  tliat  the  sudden  disappearance  of  a  gouty  swelling  is 
sometimes  followed  by  such  an  outbreak.  After  the  cessation 
of  the  inflammation  of  the  joints  gouty  mania  sometimes  occurs, 
characterized  by  acutely  maniacal  symptoms,  with  heat  of  head 
aud  fever;  ending  favourably  in  the  slighter  cases,  but  in 
severer  cases  passing  into  inflammation  of  the  membranes, 
serous  effusion,  and  coma.  Lord  Chatham,  who  was  so  great  a 
martyr  to  the  disease,  had  an  attack  of  distressing  melancholy 
lasting  for  nearly  two  years,  from  which  he  only  recovered  after 
an  attack  of  the  usual  gouty  paroxj^sm,  which  had  not  occurred 
once  during  the  season  of  his  mental  disorder.  Most  writers  on 
insanity  and  on  gout  make  mention  of  persons  subject  to  fre- 
quent attacks  of  gout  who  had  none  while  sutfering  from  an 
attack  of  insanity. 

It  admits  of  no  question  that  every  degree  of  mental  disorder, 
from  the  mildest  feeling  of  melancholic  depression  to  the  extrem- 
est  fury  of  delirium,  may  be  due  to  the  non-evacuation  from  the 
blood  of  the  waste  matters  of  the  tissues  ;  but  as  we  know  very 
little  at  present  of  the  nature  of  those  waste  products  of  retro- 
grade metamorphosis,  and  of  the  different  transformations  which 
they  undergo  in  the  body  before  they  are  eliminated  by  excre- 
tion, we  must  rest  content  with  the  general  statement,  and  set 
ourselves  in  practice  to  prosecute  rigorous  inquiries  into  the  par- 
ticular instances.  Irregularities  of  menstruation,  which  are  so  com- 
mon in  insanity,  are  of  importance  in  regard  to  this  question; 
the  return  of  the  function  at  its  due  season  not  un frequently 
heralding  recovery,  and,  on  the  other  hand,  severe  exacerbations 
of  epilepsy  and  insanity  coinciding  often  with  the  menstrual 
period.  Whether  the  case  be  one  of  mere  retention  in  the 
blood  of  what  should  be  excreted  from  it,  or  whether  nervous 
sympathy  plays  the  greater  part  in  what  takes  place,  I  know 
not ;  but  there  can  be  no  doubt  of  the  fact  that  menstruation  is 
oftentimes  suppressed  during  an  attack  of  mental  derangement, 
and  of  the  second  fact  that  cases  are  on  record,  more  or  less 
like  that  well-known  one  related  by  Esquirol  of  an  insane  girl 


198  PATHOLOGY  OF  MIND.  [chap. 

whose  menses  had  ceased  for  some  lime,  and  who  recovered  her 
senses  directly  they  began  to  flow. 

When  we  reflect  that  the  blood  is  itself  a  living,  developing 
fluid, — that,  "burnished  with  a  living  splendour,"  it  circulates 
through  the  body,  supplying  the  material  for  the  nutrition  of 
the  various  tissues,  receiving  again  their  waste  matter  and 
carrying  it  to  those  parts  where  it  may  either  be  appropriated 
by  nutrition  or  eliminated  by  secretion, — it  is  plain  that  multi- 
tudinous changes  are  continually  taking  place  in  its  constitution 
and  composition  ;  that  its  existence  is  a  continued  metastasis. 
There  is  wide  possibility,  therefore,  as  there  is  partial  evidence, 
of  abnormal  changes  in '  some  of  the  manifold  processes  of  its 
complex  life  and  function,  such  as  may  generate  products 
hurtful  or  fatal  to  the  nutrition  of  the  different  tissues.  Tlie 
blood  itself  may  not  reach  its  proper  growth  and  development 
by  reason  of  some  defect  in  the  function  of  the  glands  that 
minister  to  its  formation,  or,  carrying  the  cause  still  further 
back,  by  reason  of  insufficient  food  and  of  wretched  conditions 
of  life ;  there  is  in  consequence  a  defective  nutrition  generally, 
as  in  scrofulous  persons,  and  the  nervous  system  shares  in  the 
general  delicacy  of  constitution ;  though  quickly  impressible 
and  lively  in  reaction,  it  is  irritable,  feeble,  and  easily  exhausted. 
Poverty  of  blood,  without  doubt,  plays  the  same  weighty  part 
in  the  production  of  insanity  as  it  does  in  the  production  of 
other  nervous  diseases,  such  as  hysteria,  chorea,  neuralgia,  and 
even  epilepsy.  In  the  condition  known  as  anaemia,  we  have  an 
observable  defect  in  the  blood  and  palpable  nervous  suffering 
in  consequence;  headaches,  singing  in  the  ears,  sparks  of  light 
before  the  eyes,  giddiness,  low  spirits,  and  susceptibility  to 
emotional  excitement  reveal  the  morbid  effects.  The  exhaustion 
produced  by  lactation  in  some  constitutions  is  a  recognized 
cause  of  mental  derangement;  and  a  great  loss  of  blood  during 
childbirth  has  sometimes  occasioned  a  sudden  outbreak.  The 
delirium  of  starvation  is  probably  an  anaemic  delirium ;  it 
is  marked  by  mental  prostration  and  imbecility  in  the 
beginning,  and  then  by  maniacal  delirium,  perhaps  with  visual 
hallucinations,  which  is  followed  by  coma  and  death,  with  or 
without  convulsions. 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       199 

While  we  can  detect  an  evil  so  obvious  as  a  great  loss  of  blood 
or  a  deficiency  of  iron  in  the  blood,  there  are  good  reasons  to 
think  that  other  graver  defects  in  its  constitution  or  develop- 
ment, of  which  we  can  give  no  account  at  present,  do  exist  and 
give  rise  to  secondary  nervous  degeneration.  It  is  in  this  way 
probably  that  ill  conditions  of  existence, — as  overcrowding,  bad 
air,  insufficient  food  and  light,  intemperance,  and  the  like, — lead 
to  defects  of  nervous  development,  or  to  actual  arrest  thereof, 
and  thus  produce  mental  as  well  as  physical  deterioration  of  the 
race.  Leucocythcemia,  oxcduria,  and  pJiosjyMiria  are  states  of  de- 
fective nutrition  owing  to  imperfect  digestion  and  assimilation, 
in  which  symptoms  of  mental  discomfort  or  distress  are  common 
and  notable.  Persons  who  suffer  from  oxaluria  are  usually  much 
depressed,  anxious  or  apprehensive  about  themselves,  hypochon- 
driacal, nervous  and  susceptible ;  in  phosphuria  there  is  com- 
monly also  great  nervous  irritability  ;  and  the  late  Dr.  Skae 
thought  that  there  was  a  form  of  insanity  of  a  melancholic  type 
associated  with  or  directly  dependent  upon  each  of  these  condi- 
tions. I  know  not  under  what  more  fitting  heading  than  deterio- 
ration of  blood  to  place  the  mental  derangement  which  occurs 
in  jpellagra,  and  is  called  ^:>c//a^roi«s ;  for,  being  caused  by  the 
use  of  diseased  Indian  corn  as  an  article  of  food,  it  is  a  condition 
of  great  bodily  and  mental  debility.  The  symptoms  are  usually 
those  of  melancholy  and  fatuity  with  propensity  to  suicide; 
sometimes  they  are  maniacal ;  and  some  cases  are  said  to  evince 
a  singular  dislike  to  the  sight  or  touch  of  water  because  of  the 
vertigo  which  it  instantly  produces. 

There  is  no  want  of  evidence  that  organic  morbid  poisons, 
bred  in  the  organism  or  introduced  into  it  from  without,  will 
act  in  the  most  baneful  manner  upon  the  supreme  nervous 
centres.  With  what  quick  destructive  force  certain  morbid 
materials  bred  in  the  blood,  or  passing  into  it,  may  act,  is 
shown  in  certain  cases  of  so-called  putrid  infection  in  which 
the  patient  dies  after  an  injury  or  a  surgical  operation  before 
there  has  been  time  to  feel  the  after-consequences,  or  in  some 
cases  of  malignant  typhus  where  the  virus  is  directly  fatal  to 
nerve  element  before  the  fever  has  had  time  to  develop  itself. 
It  is  probable  enough  that  a  virus  which,  when  concentrated. 


200  PATHOLOGY  OF  MIND.  [chap. 

produces  fatal  results,  will,  when  acting  with  less  intensity, 
give  rise  to  nervous  derangement  which  stops  short  of  death. 
That  organic  poisons  do  act  in  a  definite  manner  on  the  organic 
elements,  and  give  rise  to  definite  morbid  actions,  is  proved  by 
the  constant  symptoms  of  such  diseases  as  syphilis  and  small- 
pox. Now  the  general  laws  observable  in  the  actions  of  morbid 
poisons  appear  for  the  most  part  to  be  like  those  which  govern 
the  action  of  medicinal  substances ;  and  as  the  Woorara  poison 
completely  paralyzes  the  ends  of  the  motor  nerves  and  does  not 
affect  the  muscles  or  the  sensory  nerves,  or  as  strychnia  poisons 
the  spinal  centres,  and  leaves  the  cerebral  centres  unaffected,  so 
it  is  conceivable  that  a  particular  organic  virus  may  have  a 
predominant  affinity  for  a  particular  nervous  centre  and  work 
its  mischievous  work  there.  Whether  that  be  so  or  not,  what 
we  do  notice  is  that  in  some  conditions,  natural  or  acquired,  of 
the  nervous  system  a  morbid  poison  does  act  with  particular 
intensity  upon  it  or  show  a  particular  affinity  for  it.  The 
syphilitic  virus  usually  affects  the  nervous  system  more  or  less 
severely  at  one  period  or  other  of  its  action  ;  but  in  some 
instances  it  appears  to  attack  the  nervous  system  specially,  or 
to  concentrate  its  action  upon  it,  giving  rise  to  an  acute  mania 
at  an  early  stage  of  its  course.  Commonly,  however,  it  is  at  a 
much  later  stage  that  the  brain  suffers,  when  syphilitic  pro- 
ducts, so-called  gummata,  are  formed  on  its  surface,  or  within 
its  substance,  and  dementia  gradually  ensues  in  consequence. 

There  are  cases  on  record,  again,  in  which  mental  derangement 
has  appeared  as  the  intermittent  symptoms  of  ague ;  instead  of 
the  usual  symptoms  of  ague  the  patient  has  had  an  intermittent 
insanity  in  regular  tertian  or  quartan  attacks,  and  has  been  cured 
by  the  treatment  for  intermittent  fever. ^  Sydenham  observed  and 

1  A  young  man  in  an  agueish  district  suffered  from  five  brief  attacks  of 
mental  derangement,  one  occurring  every  other  day.  The  attacks  began 
with  an  indescribable  feeling  of  pain  in  the  region  of  the  heart,  and  with 
strong  pulsations  of  the  heart.  This  was  the  starting-point  of  the  deli- 
rium,from  which  the  patient  recovered  alter  a  deep  sleep.  He  was  cured 
by  quinine. — A  strong  peasant,  aged  thirty,  M^ho  had  never  had  ague 
tliough  he  lived  in  an  agueish  district,  was  suddenly  attacked  with  insanity. 
He  believed  himself  to  be  Jesus  Christ,  and  those  near  him  to  be  witches, 
and  acted  with  violence  towards  them.  His  head  was  hot ;  his  eyes  were 
red  and  wild  ;  his  pulse  was  quick  and  his  tongue  white.     After  cupping 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       201 

described  a  species  of  mania  supervening  on  an  epidemic  of  in- 
termittent fever ;  contrary  to  all  other  kinds  of  madness,  lie  says, 
it  would  not  yield  to  plentiful  venesection  and  purging ;  sliglic 
evacuations  producing  the  relapse  of  a  convalescent,  and  vio- 
lent ones  inevitably  rendering  the  patients  idiotic  and  incurable. 

Griesinger  and  others  direct  special  attention  to  cases  in 
which  mental  disorder  has  occurred  in  the  course  of  acute 
rheumatism,  the  swelling  of  the  joints  meanwhile  subsiding. 
The  patient  ceases  to  complain  of  pain  in  the  joints  and  be- 
comes delirous ;  the  excitement  which  he  shows  is  of  an  in- 
tense kind,  too  raging  to  leave  him  sensible  to  impressions ; 
he  evinces  acute  fear,  and  would  jump  out  of  the  window 
or  do  some  other  act  of  unreasoning  violence  to  himself.  After 
the  excitement  is  over  there  is  much  mental  torpor  and 
confusion,  or  there  is  depression  with  taciturnity  and  moody 
suspicions.  Choreic  movements  of  all  the  voluntary  muscles, 
sometimes  of  a  violent  character,  may  accompany  the  mental 
symptoms,  and  are  in  a  few  cases  followed  by  temporary  para- 
lysis. It  is  by  no  means  certain,  however,  that  a  delirium  of 
this  sort  is  due  to  the  action  of  a  morbid  or  other  poison ;  it 
may  be  due  to  an  actual  transference  or  so-called  metastasis  of 
the  disease,  or  to  other  causes  ;  for  we  know  by  other  experience 
that  morbid  action  in  one  part  may  overpower  and  suspend 
morbid  action  in  another  part  of  the  body,  as  when  an  attack 
of  insanity  suspends  the  progress  of  phthisis  or  the  paroxysms 
of  asthma,  while  it  lasts,  or  as  when  a  violent  mania  occasions 
the  suppression  of  an  accustomed  discharge. 

The  viruses  of  acute  fevers,  as  typhus  and  typhoid,  scarlatina 
and  smallpox,  may  notably  act  in  the  most  positive  manner 
on  the  supreme  nervous  cells,  giving  rise  to  mental  torpor  and 
stupidity,  or  to  an  active  delirium ;  and,  where  they  do  not  act 
directly  at  the  height  of  the  fever  to  produce  delirium,  they  still 
predispose  sometimes  to  an  outbreak  of  insanity  during  the  de- 
cline of  the  acute  disease — a  post-febrile  insanity.  Kot  only  may 

and  the  application  of  ice  to  the  head,  he  recovered,  and  for  two  days 
remained  quite  sound  in  mind.  On  the  fourth  day,  however,  exactly  at 
the  same  time,  he  had  a  similar  attack,  and  again  a  third,  after  three  days 
more.  He  was  cured  by  quinine. — Die  Pathologie  und  Therapie  tier 
paychischen  Kranlcheiten.     Von  Dr.  W.  Griesinger. 


202  rATIIOLOGY  OF  MIND.  [chap. 

a  morbid  poison  thus  attack  the  nervous  system,  or  a  part  of  it, 
but  it  should  be  borne  in  mind  that  a  particular  virus  "svill 
most  likely  have  its  special  effect,  not  otherwise  than  as  tea 
and  coffee  produce  wakefulness,  while  ojjium  produces  sleep. 

The  first  and  mildest  mental  effect  of  a  perverted  state  of 
blood  is  not  positive  delusion  or  incoherence  of  thought,  but  a 
derangement  of  the  mental  tone.  Feelings  of  singular  discomfort 
or  depression,  of  irritability  or  uneasiness,  testify  to  some  modifi- 
cation of  the  statical  condition  of  nervous  element ;  and  a  great 
disposition  to  uneasy  emotion  is  the  subjective  side  of  this 
state — the  psychosis  which  is  the  expression  of  the  disturbed 
neurosis.  It  may  exist  in  different  degrees  of  intensity,  from 
the  slight  irritability  or  gloom  which  goes  along  with  a  sluggish 
liver,  or  the  greater  irritability  which  the  urea  in  the  blood  of 
the  gouty  subject  produces,  to  that  profound  depression  which 
we  describe  as  melancholia,  or  that  active  degeneration  of 
function  which  we  designate  mania.  Though  there  may  be  no 
positive  delusion,  the  emotional  perversion  existing  by  itself, 
the  ideas  which  arise  under  such  circumstances  do  not  fail  to 
show  the  influence  of  the  morbid  feeling  with  which  they  are 
strongly  tinctured  ;  they  are  obscure,  or  painful,  or,  at  any  rate, 
not  clear  and  faithfully  representative  of  external  circumstances. 
The  morbid  character  of  the  depression  lies,  not  in  the  depres- 
sion itself,  which  would  be  natural  or  normal  so  long  as  there 
was  an  adequate  external  cause  of  it,  but  in  its  existence 
w^ithout  any  external  cause — in  the  discord  between  the  indi- 
vidual and  his  circumstances.  But  as  it  is  an  irresistible  dis- 
position of  the  mind  to  represent  its  feelings  as  qualities  of  the 
external  object ;  as  in  all  our  mental  life  we  continually  make 
this  projection  outwards  of  our  subjective  states — it  commonly 
happens  after  a  while  that  the  victim  of  an  internally  caused 
emotional  perversion  seeks  for  an  objective  cause  of  it, 
and,  thinking  to  find  one,  gets  a  delusion:  being  in  discord 
with  the  external,  he  establishes  an  equilibrium  between  himself 
and  it  by  creation  of  ideal  surroundings  in  harmony  with  his 
inner  life.  The  form  which  the  delusion  takes  may  be  a  natural 
crystallization  or  condensation,  so  to  speak,  of  the  particular  mor- 
bid emotion  which  prevails,  in  which  case  the  most  trivial  event 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       203 

may  be  overcliarged  with  disproportionate  emotion,  and  magnified 
into  a  mighty  trouble ;  or  it  may  be  suggested,  as  it  often  is,  by 
some  prominent  external  event.  What  we  have  to  bear  in  mind 
witli  regard  to  the  organic  nature  of  the  delusion  is,  that  certain 
ideational  tracks  have  now  entered  upon  the  habit  of  a  definite 
morbid  action ;  that  the  general  commotion  of  nerve  element, 
which  the  emotional  disturbance  implied,  has  now  brought  itself 
to  a  head  in  a  particular  form  of  diseased  action  ;  not  otherwise 
than  as  general  inflammatory  disturbance  of  some  part  of  the 
organism  issues  in  a  definite  morbid  growth  there.  For  although 
a  temporary  emotional  disturbance  produced  by  bad  blood  may 
completely  pass  away  with  the  purification  of  the  blood,  yet 
the  prolonged  continuance  or  frequent  recurrence  of  such  mor- 
bid influence  will  inevitably  end  in  the  ideational  centres,  as 
elsewhere,  in  chronic  morbid  action,  which,  once  established,  is 
not  easily  got  rid  of 

We  may  compare  the  growth  of  a  delusion  with  the  mode  of 
production  of  a  general  idea.  As  the  general  idea  is  formed  by 
assimilation  of  the  like  and  by  rejection  of  the  unlike  in 
impressions — by  respondence,  that  is,  to  similar  and  indifference 
to  dissimilar  vibrations ;  so  in  the  growth  of  a  delusion  in  the 
mind  there  is  a  respondence  to,  and  therefore  an  affinity  for  or 
natural  selection  of,  impressions  that  harmonize  with  it,  while 
those  that  are  not  in  harmony  with  it  are  ignored.  It  is  useless 
to  argue  against  an  insane  delusion  ;  it  has  taken  a  predominant 
possession  of  consciousness,  and  there  is  a  discontinuity  of 
function  between  its  tract  and  surrounding  parts ;  reasoning 
can  gain  no  hold  of  it  any  more  than  surrounding  healthy 
nutrition  can  gain  hold  of  a  tumour  or  other  morbid  growth  to 
check  it.  But  the  gradual  influence  of  favourable  surroundings 
— to  w^it,  a  suitable  moral  atmosphere,  distracting  occupations, 
diverting  amusements,  a  steady  reasonableness  of  life — will  exert 
an  unconscious  beneficial  influence  upon  the  uninfected  mental 
organization,  until  the  large  part  of  it  which  lies  outside  the 
morbid  area  gains  strength  enough  to  have  a  controlling  hold 
of  the  morbid  action  and  to  bring  it  by  degrees  into  subordina- 
tion to  the  laws  of  healthy  function.  Then  the  quasi- cataleptic 
bondage   of    consciousness  is   loosened,   and   discontinuity    of 


204  PATHOLOGY  OF  MIND.  [chap. 

function  is  at  an  end ;  the  individual  first  suspects,  then  doubts, 
finally  disbelieves  his  delusion. 

It  appears  from  what  I  have  said  that  the  first  effect  of  the 
chronic  action  of  impure  blood  is  to  produce  a  general  disturb- 
ance of  the  psychical  tone,  or  indefinite  morbid  emotion ;  and 
that  the  further  eflTect  of  its  continued  action  is  to  eni^ender  a 
chronic  delusion  of  some  kind — a  systematization  of  the  morbid 
action.     But  a  third  effect  of  its  more  acute  action,  as  witnessed 
in   the   effects   of  acute   fevers  and   of   certain   poisons,   is  to 
produce  more  or  less  active  delirium  and  general  incoherence 
of  thought :   the   poison  is   distributed  generally   through  the 
supreme  centres  by  the  circulation,  and,  acting  directly  upon 
them,  excites  ideas  rapidly  and  without  order  or  coherence :  the 
delirium  is  not  systematic,  and  there  is  good  hope  of  its  pass- 
ing  away.     The  approaches  of  this  sort  of   delirium  in  fever 
illustrate  many  of  the  phenomena  of  insanity.     Eirst,  there  are 
wandering  thoughts  and  visions,  known  to  be  unreal,  which  are 
described  by  the  patient,  who   recognizes   their   character,    as 
nonsense ;  then  there  follow  vague  rambling  talk,  from  which 
he  may  be  aroused  by  talking  to  him,  though  he  falls  back  into 
it  as  soon  as  he  has  answered,  and  visions,  about  the  reality  of 
which  he  is  uncertain  and  confused,  assenting,  perhaps,  when 
assured  that  they  are  unreal,  but  relapsing  instantly  afterwards 
into  belief  in  them ;    afterwards,  as  the   disorder   gets  deeper 
hold,   a   state  of  complete  delirium   ensues,   when   he  cannot 
distinguish  between  the  real  and  the  unreal,  and  the  mind  is 
entirely  possessed  by  unreal  images  and  false  thoughts  uncon- 
trolled by  impressions  from  without.     It  is  a  singular  fact  that 
notwithstanding  this  febrile  delirium  resembles  mania  in  many 
respects,  when  its  phenomena  are  analyzed,  and  notwithstanding 
that  its  seat  in  the  brain  must  be  the  same  as  that  of  mania,  it 
never  does  run  on  without  intermission  into  that  post-febrile 
mania  which  sometimes  occurs  during  convalescence.   The  febrile 
delirium  is  clearly  an  incident  or  attribute,  so  to  speak,  of  the 
morbid  process  of  the  fever,  coming  and  going  therefore  with 
it ;  the  post-febrile  mania  is  essentially  a  derangement  of  mind, 
to  which  the  fever  has  been  a  powerful  predisposing  cause,  as 
any  other  severe  bodily  illness  might  have  been.      It  is  to  be 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       205 

noted,  however,  that  a  fixed  idea  has  continued  sometimes  for 
a  considerable  time  after  the  general  delirium  of  fever :  take, 
for  example,  the  case  of  the  physician  who,  after  an  attack  of 
typhus  fever,  believed  for  six  months  that  he  possessed  a 
country  house  and  a  white  horse,  neither  of  which  had  any 
existence  except  in  his  imagination. 

It  is  necessary  to  apprehend  clearly,  and  to  keep  steadily  in 
mind,  that  the  relation  between  the  supreme  nervous  centres  and 
the  blood  is  fundamentally  of  the  same  kind  as  that  between 
other  parts  of  the  body  and  their  blood-supply;  and  that  the 
disordered  mental  phenomena  are  the  functional  exponents  of 
morbid  organic  action.  Firmly  grasping  this  just  conception, 
as  we  may  do  by  calling  to  mind  the  mode  of  nutritive  action 
in  other  parts  of  the  body,  we  get  rid  of  the  notion  of  a  delu- 
sion as  some  abstract,  ideal,  and  incomprehensible  entity  which 
comes,  we  know  not  how,  and  recognize  it  as  the  mental 
expression  of  a  definite  morbid  action  in  one  or  other  of  the 
supreme  centres ;  neither  more  nor  less  wonderful,  therefore,  than 
the  persistence  of  a  definite  morbid  action  in  any  other  organ. 
If  at  a  time  when  there  is  defective  or  disordered  nutrition 
of  the  brain  some  striking  event  or  some  powerful  shock  pro- 
duces an  extraordinary  impression  on  the  mind,  constraining  it 
into  a  particular  form  of  activity — in  other  words,  engrossing 
its  whole  energy  in  a  particular  gloomy  reflection ;  or  if  the 
individual's  natural  habit  of  thought  be  of  a  suspicious,  of  a 
vainly  conceited,  or  of  a  despairing  character;  what  more  in 
accordance  with  analogy  than  that  the  predominant  activity, 
temporary  or  habitual,  should  take  on  a  chronic  morbid  action, 
and  issue  in  the  production  of  a  delusion  ?  Any  great  passion 
in  the  sound  mind  notably  calls  up  kindred  ideas,  which  there- 
upon tend  to  keep  it  up ;  the  evil  eye  of  envy,  the  green  eye  of 
jealousy  sees  only  what  feeds  the  passion ;  and  it  is  plain  that 
the  morbid  exaggeration  of  this  natural  process  must  lead  in  a 
weakened  brain  to  the  production  of  insane  delusion. 

3.  Byni'pailiy  or  Reflex  Irritation. — Like  every  other  nervous 
centre,  or  like  any  other  part  of  the  organism,  the  ideational 
centres  may  be  deranged  by  a  morbid  irritation  in  a  distant 
part  of  the  body.     Why  such  morbid  effects  should  be  produced 


206  PATHOLOGY  OF  MIND.  [chap. 

at  one  time  and  not  at  another,  or  in  one  person  and  not  in 
another,  when  the  cause  of  irritation  appears  to  be  of  the  same 
strength  and  character  in  each,  it  is  impossible  to  say,  just  as  it 
is  impossible  to  explain  how  it  is  that  a  wound  in  the  hand  or 
elsewhere  gives  rise  to  tetanus  at  one  time  and  at  another  time 
to  no  such  desperate  consequence,  or  Avhy  epilepsy  should  be 
caused  by  an  eccentric  irritation  in  one  case  and  not  in  another. 
"  A  fever,  delirium,  and  violent  convulsions,"  says  Dr.  Whytt, 
"have  been  produced  by  a  pin  sticking  in  the  coats  of  the 
stomach ;  and  worms  affecting  either  this  part  or  the  intestines 
occasion  a  surprising  variety  of  symptoms."  ^ 

Hippocrates  ascribed  to  sympathy  the  occurrence  of  certain 
disorders  which  seemed  to  have  no  other  cause  than  disease 
elsewhere  in  the  body,  and  both  Aretoeus  and  Galen  were  aware 
that  the  mind  might  be  deranged  by  disease  in  other  parts  of 
the  body  than  the  brain.  On  the  whole,  perhaps  sympathy  was 
as  good  a  seeming  explanation  of  these  effects  as  the  modern 
doctrine  of  reflex  action ;  for  the  doctrine  of  a  pathological 
sympathy  certainly  brought  into  proper  light  the  momentous 
truth  that  the  living  organism  is  not  mere  mechanism,  but  a 
physiological  unity  having  an  intimate  and  entire  consent  of 
function.  When  we  speak  of  reflex  action,  what  is  usually 
meant  is  the  transference  of  excitement  from  a  sensory  to  a 
motor  nerve  ;  but  the  reflexion  may  be  in  the  opposite  direction 
— from  the  motor  to  the  sensory  nerve,  as,  for  example,  when 
severe  pain  along  the  spine  follows  violent  coughing,  or  a 
tickling  of  the  throat  is  felt  after  long  speaking,  or  facial 
neuralgia  is  increased  by  muscular  exertion.^  Moreover,  the 
reflexion  may  be  from  sensory  nerve  to  sensory  nerve  :  witness 
the  pain  in  the  knee  which  betrays  disease  in  the  hip-joint,  the 
facial  neuralgia  which  is  excited  by  a  toothache,  and  the  pain 
of  a  toothache  that  is  felt  in  a  neighbouring  or  in  an  opposite 
tooth.  So  many  and  various  are  these  pathological  and  physio- 
logical reflex  actions  that  we  shall  perhaps  for  the  present  do 
best  to  embrace  them  under  the  wide  term — sympathy. 

^  Observations  on  the  Nature,  Causes,  and  Cure  of  Nervous,  Ilypoclion- 
driacal,  or  Hysteric  Disorders.     By  Robert  Whytt,  INI.D.     1765. 
2  Henle,  Handbuch  der  Raiion&llen  Pathologie.     1846. 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       207 

Amongst  many  other  instances  wliicli  might  be  quoted  to 
illustrate  this  manner  of  pathological  action  is  a  striking  case 
recorded  by  Baron  Larrey.  A  soldier,  who  had  been  shot  in 
the  abdomen,  had  a  fistulous  opening  on  the  right  side,  which 
passed  inwards  and  towards  the  left.  When  a  sound  was  intro- 
duced into  this  opening  and  made  to  touch  the  deeper  parts,  im- 
mediately singular  attacks  supervened :  first  there  was  a  feeling 
of  coldness  and  oppressive  pain,  then  a  convulsive  contraction  of 
the  abdomen  and  spasm  of  the  limbs  took  place ;  after  which  the 
man  fell  into  a  sort  of  somnambulism,  and  talked  incoherently, 
this  stage  ending  after  about  thirty  minutes  in  a  melancholy 
depression  which  from  the  time  of  the  wound  had  been  habitual. 
Larrey  attributed  the  hypochondria  and  other  nervous  symptoms 
to  the  injury  which  the  cseliac  axis  had  suffered  from  the  balL 
The  direct  effect  of  the  sympathetic  system  upon  the  brain,  of 
which  this  case  yields  a  striking  illustration,  Schroeder  van  der 
Kolk  once  verified  painfully  in  his  own  experience.^  After 
great  mental  exertion  and  an  unaccustomed  constipation  of  a 
few  days,  he  was  attacked  with  a  fever,  for  which  his  physician, 
deeming  it  nervous,  would  not  sanction  any  purging.  AYhen 
the  fever  had  lasted  for  two  days,  hallucinations  of  vision 
occurred ;  he  saw  distinctly  a  multitude  of  people  around  him, 
although  he  w^as  quite  conscious  that  they  were  only  phantasms. 
The  hallucinations  continued  for  three  days  and  increased,  until 
he  got  a  thorough  evacuation  of  a  quantity  of  hardened  faeces 
from  his  bowels,  wdien  they  vanished  instantly.  A  man  wdio 
came  under  my  observation,  having  suffered  for  more  than  a 
year  from  profound  melancholia,  and  who  had  become  greatly 
emaciated,  passing  at  intervals  pieces  of  tape-worm,  recovered 
almost  immediately  after  the  expulsion  of  the  whole  of  the 
worm  by  means  of  a  dose  of  the  oil  of  male-fern.^      Many  like 

^  Die  Fathologie  unci  Therapie  der  GeisteshravJcheiten  auf  Anaiomisch- 
Physiologischer  Grundlage.     Von  J.  L.  C.  Schroeder  van  der  Kolk.     1863. 

2  Griesinger  has  seen  deep  melancholia  occur  in  a  hysterical  woman 
after  accidental  wound  of  the  eye  by  a  sphnter.  Herzog  relates  an  instance 
of  insanity  after  the  operation  for  strabismus.  Jordens  tells  of  a  boy  who 
was  attacked  with  furious  insanity  in  consequence  of  a  splinter  of  glass  in 
the  sole  of  his  foot,  which  disappeared  directly  it  was  removed. — OjJ.  cit., 
p.  183.     See  also  a  case  related  in  Physiology  of  Mind.,  p.  253. 

*■'  In  two  instances,"  says  Dr.  Burrows,  in  his  Commentaries  on  Insanity^ 

10 


208  PATHOLOGY  OF  MIND.  [chap. 

cases  are  on  record  in  medical  books ;  but  it  is  not  necessary  to 
mnltiply  instances  in  order  to  prove  that  a  morbid  irritation 
in  some  distant  part  or  organ  of  the  body  may  be  the  cause 
of  secondary  functional  and  organic  disorder  of  the  supreme 
nervous  centres. 

Affections  of  the  uterus  and  its  appendages  afford  notable 
examples  of  a  powerful  sympathetic  action  upon  the  brain,  and 
not  unfrequently  play  an  important  part  in  the  production  of 
insanity,  especially  of  melancholia.  Perhaps  the  best  oppor- 
tunity of  studying  the  early  stages  of  the  genesis  of  melancholia 
is  afforded  by  the  mental  depression  accompanying  certain 
uterine  diseases.  M.  Azam  investigated  the  histories  of  seven 
cases  of  lypemania  with  suicidal  tendencies,  of  one  case  of 
simple  lypemania  with  dangerous  tendencies,  and  of  one  case  of 
hysteromania.  He  professed  to  have  found  granulations  of  the 
neck  of  the  uterus  in  five  cases ;  antevqrsion  of  the  uterus,  with 
congestion  of  its  neck  and  ulceration  of  the  inferior  lip,  in  one 
case  ;  in  three  cases  fungous  and  fibrous  growths  of  the  uterus ; 
and  in  one  case  painful  engorgement  of  it  with  leucorrhoea. 
Schroeder  van  der  Kolk  relates  the  case  of  a  profoundly  melan- 
cholic woman,  who  suffered  at  the  same  time  from  prolapsus 
uteri,  and  in  whom  the  melancholia  used  to  disappear  directly 
the  uterus  was  restored  to  its  proper  place  ;  Flemming  mentions 
two  similar  cases  in  which  the  melancholia  was  cured  by  the 
use  of  a  pessary,  in  one  of  them  returning  regularly  whenever 
the  pessary  was  removed  ;  and  in  one  instance  I  saw  severe 
melancholia  of  two  years'  duration  disappear  after  the  cure  of 
a  prolapsus  uteri.  Instances  are  on  record  in  which  a  woman 
has  regularly  become  insane  during  each  pregnancy;  and,  on 

'*I  have  known  sudden  mania  originate  from  the  irritation  of  cutting  the 
denies  sainentice."  .  .  .  "  Violent  nausea  also  from  sea-sickness,  con- 
tinued for  a  few  hours,  has  produced  mania  in  three  instances  within  my 
knowledge." 

M.  Laurent  {Annales  Ifedico-PsycJioIogique,  1867)  relates  a  case  of  acute 
delirium  with  refusal  of  food  ending  in  death,  wliich  he  ascribed  to  an 
ascaris  lumbricoides  that  was  found,  after  death,  in  the  woman's  oesophngiis. 
A  sister  had  died  insane.  On  making  literary  researches  he  found  cases 
recorded  by  Esquirol  and  other  authors  in  which  the  presence  of  the  worm 
in  the  stomach  or  oesophagus  had  concurred  with  violent  delirious  excite- 
ment.   The  worm  in  such  place  seems  to  be  a  njost  powerful  reflex  irritant. 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      209 

the  other  hand,  Guislain  and  Gricsinger  mention  a  case  re- 
spectively in  which  insanity  disappeared  during  pregnancy, 
the  patient  at  that  time  only  being  rational.  I  have  met  with  a 
similar  case  in  which  a  melancholic  and  rather  weak-minded 
woman  w\as  never  sane  except  when  she  was  pregnant;  and 
another  instance  of  a  young  married  woman  who,  much  tor- 
mented hy  homicidal  feelings,  was  free  from  them  during 
pregnancy.  The  late  Dr.  Skae  included  among  his  varieties  of 
mental  disorder  one  which  he  called  the  insanity  of  pregnancy ; 
the  chief  special  characteristic  of  which  seems  to  have  been 
that  it  occurred  during  pregnancy,  and  might  sometimes  be 
looked  upon  as  a  morbid  exaggeration  of  the  peculiar  mental 
moods  exhibited  by  some  women  when  in  that  state.^ 

It  is  uncertain  whether  the  puerperal  state  acts  as  the  occa- 
sional cause  of  a  maniacal  outbreak  by  a  kind  of  sympathetic 
action,  or  whether  it  acts  in  some  other  way ;  but  there  can  be 
no  doubt  of  the  fact  that  a  woman  is  sometimes  attacked  with 
mental  alienation  during  or  immediately  after  delivery,  and  that 
her  child  may  fall  a  victim  to  her  frenzy.  This  form  of  puer- 
peral insanity  is  different  from  the  insanity  of  pregnancy ;  dif- 
ferent again  from  that  which  occurs  at  a  lattsr  period  after 
delivery,  and  which  is  then  probably  due  either  to  some  sort  of 
blood-poisoning,  or  to  a  moral  or  physical  shock  undergone  when 
the  nervous  system  is  in  a  very  susceptible  state ;  and  different 
again  from  that  mental  disorder  occurring  some  weeks  or  months 
after,  and  due  seemingly  to  the  exhaustion  produced  by  lactation, 
together  with  depressing  moral  influences.  Under  the  name  of 
Puerperal  Insanity  have  been  generally  confounded  three  morbid 
states — namely,  the  Insanity  of  Pregnancy,  Puerperal  Insanity, 
and  Insanity  of  Lactation.  Of  155  cases  of  so-calLed  Puerperal 
Insanity  admitted  into  the  Edinburgh  Asylum,  28  or  18-06  per 
cent,  w^ere  cases  of  the  Insanity  of  Pregnancy ;  73  or  47'09  per 

^  Slienck  relates  the  history  of  a  pregnant  female,  in  whom  the  sight  of 
the  bare  arm  of  a  baker  excited  so  great  a  desire  to  bite  and  devour  it, 
that  she  compelled  her  husband  to  offer  money  to  the  baker  to  allow  her 
only  a  bite  or  two  from  his  arm.  He  mentions  another  pregnant  female, 
w-ho  had  such  an  urgent  desire  to  eat  the  flesh  of  her  husband,  that  she 
killed  him  and  pickled  the  flesh,  that  it  might  serve  for  several  banquets. 
(Prochaska  on  the  Nervous  System^  Syd.  Soc.  translation.) 


210  PATHOLOGY  OF  MIND.  [chap. 

cent,  were  cases  of  Puerperal  Insanity  proper ;  54  or  34*8  per 
cent,  were  cases  of  Insanity  of  Lactation.  Now  these  varieties, 
differently  caused,  often  present  some  differences  of  features.^ 

However  it  be  that  disorders  of  menstruation  act,  certain  it  is 
that  they  exercise  great  influence  on  the  causation  and  on  the 
course  of  insanity.  Most  women  are  susceptible,  irritable,  and 
capricious  at  those  periods,  any  cause  of  vexation  then  affecting 
them  much  more  seriously  than  usual ;  some  exhibit  a  dis- 
turbance of  character  which  mounts  almost  to  disease ;  and,  in 
the  insane,  exacerbations  of  the  disease  frequently  occur  then. 
In  a  few  cases,  a  sudden  suppression  of  the  menses  has  been 
followed  by  an  outbreak  of  acute  madness ;  but  more  often  the 
suppression  has  occurred  some  time  before  the  insanity,  and 
acted  as  one  link  in  the  chain  of  causes.  It  should  not  be  for- 
gotten, however,  that  the  suppression  is  not  seldom  an  effect  of 
the  mental  derangement — whether  as  the  result  of  a  strong 
sympathy  with  the  mental  trouble,  or  whether  it  be  an  instance 
of  the  same  sort  as  the  suppression  of  a  profuse  bronchitic 
discharge  and  of  other  morbid  fluxes  by  an  outbreak  of  mania  ; 
for  there  is  no  small  truth  in  the  remark  of  Heberden  that 
madness,  like  gout,  absorbs  other  distempers  and  turns  them 
to  its  own  nature.  When  menstruation  ceases  entirely  at  the 
change  of  life,  a  revolution  takes  place  in  the  system,  which 
favours  the  production  of  insanity  in  those  predisposed  to  it, 
and  is  sometimes  enough  to  produce  it.  There  is  a  variety  of 
melancholic  derangement  occurring  at  this  period  which  has 
been  described  as  climacteric  insanity.  Most  women  suffer 
some  change  of  moral  character  in  consequence  of  the 
revolution  which  the  whole  economy  of  the  constitution  under- 
goes at  the  change  of  life.  The  age  of  pleasing  is  past,  but  not 
always  the  desire  ;  morbid  jealousy,  exaggerated  religious  senti- 
ments, wearisome  hypochondriacal  sufferings,  a  propensity  to 
stimulants  are  apt  to  show  themselves :  the  main  gratification  of 
life  having  been  to  attract  attentions  and  to  enjoy  admiration, 
new  sources  of  indulgence  and  excitement  must  now  be  sought. 

^  See  a  very  careful  paper  in  the  Edinhiirgh  Medical  Journal,  1865,  on 
the  Insanity  of  Pregnancy,  Puerperal  Insanity,  and  Insanity  of  Lactation, 
by  Dr.  J.  B.  Tiike. 


v.]        THE  CAUSATION  AND  PKEVENTION  OF  INSANITY.      211 

The  earliest  effect  of  sympathetic  morbid  action  ^Yi^  be,  as  with 
vitiated  blood,  a  modification  of  the  tone  of  nerve  element,  which 
is  manifest  functionally  in  disordered  emotion.  But  the  con- 
tinued operation  of  the  morbid  cause  will  lead  to  a  systematized 
disorder  in  the  supreme  cerebral  centres  :  in  other  words,  to  the 
production  of  a  delusion  or  of  a  definite  derangement  of  thought, 
which  then  perhaps  betrays  a  distinct  relation  to  the  primary 
morbid  cause.  When,  for  example,  a  woman  with  morbid  irri- 
tation of  the  sexual  organs  has  salacious  delusions,  believing 
herself  to  be  violated  night  after  night,  or  with  uterine  or 
ovarian  disease  believes  herself  with  child  by  the  Holy  Ghost 
or  other  supernatural  means,  the  secondary  derangement  of  the 
cerebral  centres  testifies  to  the  special  effect  of  the  particular 
diseased  organ,  as  well  in  the  ideational  as  in  the  affective 
derangement;  the  delusive  interpretation  of  the  disordered 
action,  when  it  forces  itself  into  consciousness,  witnesses  to  the 
nature  of  the  primary  morbid  cause.  Dr.  Wright  ^  has  published 
the  particulars  of  a  case  of  cancer  of  the  ovaries,  uterus,  and 
omentum  in  which  the  afflicted  woman  had  horrible  delusions 
that  spirits,  who  gained  entrance  into  her  body,  were  tearing  her 
entrails,  and  that  unknown  persons  violated  her  person  during 
the  night ;  and  Dr.  Skae  mentions  another  case  of  a  woman 
who  complained  piteously  for  many  months  that  she  was  re- 
peatedly violated  every  night  through  the  rectum,  and  in  whose 
body,  after  death,  extensive  cancer  of  the  rectum  was  found.  He 
proposed  to  make  a  special  group  of  the  cases  of  insanity  asso- 
ciated with  ovarian  and  titerine  disease;  one  of  the  most  common 
symptoms  presented  by  them  being  sexual  hallucination. 

There  is  the  most  perfect  harmony,  the  most  intimate  con- 
nection or  sympathy,  between  the  different  organs  of  the  body 
as  the  expression  of  its  organic  life,  a  unity  of  the  organism 
beneath  consciousness  ;  it  is  a  connection  which,  as  Hunter 
said,  might  be  called  a  species  of  intelligence,  and  the  brain 
is  quite  aware  that  the  body  has  a  liver  or  a  stomach,  and 
feels  the  effects  of  disorder  in  any  one  of  the  organs,  without 
declaring  in  consciousness  the  cause  of  what  it  feels.  This 
unconscious     but    important   cerebral    activity,   which    is    the 

^  Edinhurgh  Medical  Journal,  1871. 


212  PATHOLOGY  OF  MIND.  [chap. 

expression  of  the  organic  sympathies  of  the  brain,  cannot  fail, 
when  rightly  apprehended,  to  teach  the  lesson,  that  every 
organic  motion,  visible  or  invisible,  sensible  or  insensible^ 
ministrant  to  the  noblest  or  to  the  humblest  uses,  does  not  pass 
away  issueless,  but  has  its  due  effect  upon  the  whole,  and  thrills 
throughout  the  most  complex  recesses  of  the  mental  life.^ 

It  often  happens  that  no  information  is  given  by  this  species 
of  organic  intelligence  until  the  primary  and  secondary  mischief 
is  far  advanced,  and  it  is  then  only  given  indirectly  in  language 
which  must  be  interpreted  by  the  light  of  pathological  know- 
ledge ;  for  while  there  is  entire  unconsciousness  of  the  primary 
disease  in  the  distant  organ,  and  an  entire  unconsciousness  of 
the  secondary  morbid  action  in  the  brain,  the  effect  may  never- 
theless be  positively  attested  by  melancholia,  delusion,  or  some 
other  form  of  mental  disorder.  Esquirol  graphically  tells 
the  story  of  a  woman  who  thought  she  had  in  her  belly  the 
whole  tribe  of  apostles,  prophets,  and  martyrs,  and  who,  when 
her  pains  were  more  than  usual,  railed  at  them  for  their  greater 
activity.  After  death  her  intestines  were  found  glued  together 
by  a  chronic  peritonitis.  I  have  seen  a  patient  suffering  from 
chronic  insanity  who  fancied  that  he  had  got  a  man  in  his 
inside,  and  who,  when  his  bowels  got  much  constipated,  as  they 
were  apt  to  do,  made  the  most  desperate  attempts,  by  vomiting 
and  otherwise,  to  get  rid  of  him.  After  a  purgative,  however, 
he  was  quite  comfortable  for  a  time,  and  his  delusion  subsided 
into  the  background.^     In  the  insanity  which  occurs  in  connec- 

1         "  Man  is  all  symmetrie, 
Full  of  proportion  one  limb  to  another, 
And  all  to  all  the  world  besides, 
Each  part  calls  the  further  brother. 
For  head  with  foot  hath  private  amity, 
And  both  with  moon  and  tides." — Gfx)rge  Herbert, 
2  In  the  Leicester  asylum  was  a  male  patient  who  had  been  there  for 
many  years,  and  who  had  been  in  the  habit  of  stating  that  there  was  a 
hundredweight  of  iron  in  his  abdomen  ;    he  would  occasionally   put   his 
hands  to  his  abdomen,  as  if  to  support  the  weight  of  metal  which  he 
believed  to  be  there ;  it  was  impossible  in  any  way  to  shake  his  rooted 
delusion.     He   suffered  from  melancholia,  was  often   very  reticent,  and 
never  communicative.     Some  time  before  his  death  he  was  observed  not 
to  take  his  food  so  well  as  usual :  he  more  frequently  pressed  his  lianda 
against  his  abdomen  ;  and  when  standing  he  leaned  slightly  forward  ;  but 


V.J        THE  CAUSATION  AND  PEEVENTION  OF  INSANITY.      213 

tion  with  phthisis,  appearing  about  the  same  time  and  goin/r 
along  with  it,  there  are  often  delusions  of  suspicion  which 
appear  to  have  their  foundation  in  the  anomalous  feelings 
incident  to  the  advance  of  the  tubercle :  one  such  patient  under 
my  care  fancied  that  he  was  maliciously  i^layed  upon  by  secret 
fire,  misinterpreting  in  this  way  the  actual  increase  of  bodily 
temperature  or  the  perversion  of  sensibility  which  he  felt ;  he 
also  imagined  that  a  filthy  disease  had  been  produced  in  his 
mouth,  the  delusion  probably  having  its  origin  in  the  perversion 
of  smell  or  of  taste  resulting  from  the  disease.  Xot  only  is  the 
remote  pathological  effect  of  a  diseased  organ  thus  revealed 
mentally  by  the  development  of  some  form  of  insanity,  but,  as 
already  pointed  out,  a  special  effect  of  the  particidar  morbid 
organ  is  sometimes  manifest  in  the  character  of  the  delusion 
which  is  formed.  It  is  by  virtue  of  this  kind  of  sympathetic 
action  that  a  person  has  dreamed  sometimes  that  he  had  a 
particular  internal  disease,  and  the  dream  has  turned  out  to  be 
prophetic.  The  recurrence  of  a  certain  mood  of  mind,  or  of 
exactly  the  same  train  of  thought  and  feeling,  or  of  the  same 
hallucination,  before  an  outbreak  of  recurrent  insanity  or  of 
epileptic  fits,  such  as  has  uniformly  gone  before  former  attacks, 
and  the  revival  of  particular  morbid  ideas,  feelings,  and  desires 
during  the  insane  paroxysm,  may  be,  and  probably  often  are, 
owing  to  a  periodical  revival  of  the  morbid  irritation  in  the 
distant  organ.  In  those  women  whose  mental  dispositions  are 
much  affected  sympathetically  at  the  menstrual  periods,  the 
same  sort  of  feelings,  susceptibilities,  caprices,  and  fancies 
notably  recur.     There  is  indeed  good  reason  to  believe  that  the 

he  never  even  once  complained  of  pain  or  other  uneasiness.  He  was  per- 
suaded to  go  to  bed.  Afterwards  the  symptoms  increased  in  severity  :  the 
abdomen  became  very  tender  on  pressure,  the  appetite  failed,  tlie  pulse 
became  Aveak  and  thready.  During  the  whole  of  his  illness  he  was  very 
silent  and  uncommunicative,  so  that  no  infomiation  could  be  obtained  by 
asking  him  questions.  He  died  a  few  days  after  taking  to  bed,  and  a  post- 
mortem examination  revealed  a  perforation  of  the  intestine,  near  the 
junction  of  the  ascending  and  transverse  colon,  sufficiently  large  to  admit 
the  tip  of  the  little  finger.  Through  this  opening  some  of  the  licpiid  faeces 
had  passed  into  the  peritoneal  cavity.  There  were  signs  of  inflammatory 
action  in  the  neighbourhood  of,  and  for  some  distance  around,  the  aperture, 
but  not  to  the  extent  which  might  have  been  expected.  The  gradually 
perforating  ulcer  was  probably  the  occasion  of  his  delusion. 


214  PATHOLOGY  OF  MIND.  [chap. 

brain  retains  something  of  the  impressions  received  from  the 
organic  life,  even  Avhen  they  are  morbid;  and  though  it  may 
forget  them  in  its  normal  state  they  will  be  revived  when  the 
morbid  state  of  the  organ  recurs,  just  as  the  experience  of  a 
dream  which  has  been  forgotten  in  the  waking  state  may  be 
remembered  in  a  subsequent  dream. 

The  disorder  of  an  internal  organ  of  the  body  notably  pro- 
duces in  all  persons  some  affection  of  the  mood  of  mind — in 
some  more,  in  some  less  ;  but  when  it  goes  beyond  affective 
disturbance  to  produce  actual  derangement  of  intellect,  we  are 
constrained  to  assume  an  individual  predisposition  to  such  de- 
rangement, inasmuch  as  it  has  not  such  effect  in  all  cases  ;  and 
this  we  commonly  find  when  we  make  proper  inquiries.  But 
what  I  would  have  particularly  noticed  here  is  that  when  persons 
have  what  is  called  a  sensitive  or  susceptible  nervous  tempera- 
ment, it  is  not  merely  that  they  are  more  powerfully  affected  in 
mind  and  body  by  external  impressions,  but  that  the  physio- 
logical sympathy  of  their  bodily  organs  is  more  acute  and  direct, 
whereby  these  answer  more  easily  and  more  actively  to  one 
another's  sufferings.  The  idiosyncrasy  of  a  person  means  not 
his  nervous  constitution  only  as  a  separate  thing,  but  the  whole 
temperament  of  his  body,  in  which  every  part  is  knit  together 
in  the  closest  unison,  the  least  element  being  felt  in  the  whole 
and  the  whole  in  each  element.  He  may  have  no  special  pre- 
disposition to  insanity  or  to  any  other  nervous  disorder,  and  yet, 
by  virtue  of  the  intensity  of  his  intrinsic  organic  sympathies, 
declaring  themselves  in  the  functions  of  his  nervous  system  as 
the  great  co-ordinating  mechanism  of  tlie  body  and  in  the 
mental  organization  as  the  crown  thereof,  he  may  be  prone  to 
suffer  seriously  in  mind  from  disorders  of  internal  organs  which 
another  person  would  feel  to  be  hardly  more  than  inconveni- 
ences. For  the  same  reason,  when  actual  derangement  of  mind 
exists  the  disorder  of  the  internal  organ  will  colour  the  symp- 
toms more  strongly  in  one  person  than  in  another.  The  philo- 
sophy which  enables  one  to  bear  an  abdominal  trouble  patiently 
may  not  suffice  to  do  the  same  service  for  another,  although  he 
exercises  as  much  of  it,  because  of. his  more  acute  organic  sym- 
pathies.    Too  close  and  direct  a  relation  of  dependence  between 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      215 

the  parts  and  the  supreme  authority  is  probably  an  ill  thing 
in  the  bodily,  as  in  the  political,  organism. 

Between  the  organic  feelings  just  considered — the  vital  senses, 
as  they  are  sometimes  called — and  the  lower  special  senses,  the 
closest  relations  exist;  in  truth,  they  run  insensibly  into  one 
another,  as  the  skin  covering  the  outside  and  the  mucous  mem- 
brane lining  the  inside  of  the  body  do.  Thus  the  digestive 
organs  have  the  closest  sympathy  with  the  senses  of  taste  and 
smell,  as  we  observe  in  the  bad  taste  accompanying  indigestion, 
and  especially  perhaps  in  the  avoidance  of  poisonous  matters  by 
animals ;  the  respiratory  organs  and  the  sense  of  smell  are  in 
like  manner  intimately  associated ;  and  the  sense  of  touch  has 
close  relations  with  the  coensesthesis.  In  insanity  these  physio- 
logical sympathies  become  the  occasions  or  the  food  of  delusions  : 
derangement  of  the  digestive  organs,  perverting  the  taste,  gives 
rise  to  the  delusion  that  the  food  is  poisoned ;  disease  in  the 
respiratory  organs  is  sometimes  the  cause  of  disagreeable  sub- 
jective smells,  which  are  thereupon  attributed  to  an  objective 
cause,  such  as  the  presence  of  offensive  emanations  or  of  a  dead 
body  in  the  room ;  and  more  or  less  loss  or  perversion  of  sensi- 
bility in  the  skin,  which  is  not  uncommon  amongst  the  insane, 
is  the  frequent  occasion  of  extravagant  delusions.  A  woman 
whose  case  Esquirol  relates,  had  complete  anaesthesia  of  the 
surface  of  the  skin :  she  believed  that  the  devil  had  carried  off 
her  body.  A  soldier  who  was  severely  wounded  at  the  battle 
of  Austerlitz  considered  himself  dead  from  that  time :  if  he 
were  asked  how  he  w^as,  he  invariably  replied,  that  "  Lambert 
no  longer  lives ;  a  cannon-ball  carried  him  away  at  Austerlitz. 
What  you  see  here  is  not  Lambert,  but  a  badly  imitated  machine," 
— which  he  failed  not  to  speak  of  as  it.  The  sensibility  of  his 
skin  was  lost. 

In  the  same  way  motor  hallucinations  occur.  A  striking 
instance  of  delusion  in  connection  with  defective  sensibility 
and  loss  of  motor  power  occurred  in  an  amiable  and  genial 
patient  who  was  once  under  my  care,  suflering  from  general 
paralysis.  As  the  disease  approached  its  end,  the  end  of  life, 
he  had  severe  epileptiform  convulsions,  which  latterly  affected 
the  left  side   only,    and   Avere   followed   by   paralysis   of  that 


216  PATHOLOGY  OF  MIND.  [chap. 

side.  But  although  the  power  of  movement  and  feeling  weie 
entirely  gone,  there  were  frequent  spasmodic  twitchings  of  the 
muscles,  and  sometimes  convulsive  contractions  so  strong  as 
to  raise  the  arm  and  leg  of  the  paralyzed  side  from  the  bed. 
The  poor  man  had  the  most  singular  delusions  respecting  these 
movements :  he  thought  that  another  patient,  who  was  perfectly 
demented  and  harmless,  had  got  hold  of  him  and  was  torment- 
ing him,  and  accordingly,  without  real  anger,  hut  with  an 
energy  of  language  that  was  habitual  to  him,  he  thus  solilo- 
quized aloud  : — "  What  a  power  that  damned  fellow  has  over 
me  ! "  Then  after  a  convulsive  paroxysm, — "  He  has  got  me 
round  the  neck,  and  you  dare  not  touch  him,  not  one  of  you. 
Oh  !  but  it  is  a  burning  shame  to  let  a  poor  fellow  be  murdered 
in  this  way  in  a  public  institution.  It's  that  boy  does  this  to 
me."  Told  that  he  was  mistaken,  he  replied, — "  You  may  as 
well  call  me  a  liar  at  once :  he  has  got  me  round  the  neck  and 
he  has  me  tight.  Oh  !  it  is  a  damned  shame  to  treat  me  in  this 
way — the  quietest  man  in  the  house."  Then  after  a  while, — 
"  It's  a  strange  power  these  lunatics  have  over  one.  Tliat  boy 
is  playing  the  devil  with  me :  he  stinks  worse  than  a  polecat : 
he'll  take  my  life,  sure  enough."  And  so  on  continually,  until 
the  stupor  of  death  overpowered  him. 

Laudably  anxious  to  give  due  weight  to  the  perversions  of 
sensibility  which  are  met  with  in  insanity,  Griesinger  made 
five  groups  of  mental  disorder  connected  with  different  anoma- 
lies of  sensibility,  and  more  frequently  than  not,  he  thought, 
actually  dependent  upon  them.  The  first  of  these  is  the  'prce- 
cordial  form,  where  there  are  morbid  sensations,  sense  of  pres- 
sure, or  of  constriction,  or  of  coldness,  or  of  fluttering,  or  of 
actual  pain  about  the  epigastrium,  upon  which  follow  fear 
and  mental  anguish,  with  corresponding  ideas  and  habits  of 
thought ;  it  is  a  disorder  of  sensibility  which  is  common  enough 
in  some  forms  of  apprehensive  and  hypochondriacal  melan- 
cholia, and  is  often  accompanied  by  an  extraordinary  alarm 
and  helplessness.  The  second  is  the  vertiginous  form,  in  which 
some  anomaly  of  muscular  sensibility  exists.  In  the  third, 
which  he  calls  the  para:st7ietical  form,  there  are  anomalous 
sensations   in    different  parts  of  the   body,    attributed   by   the 


v.]        THE  CAUSATION  AND  PEEVENTION  OF  INSANITY.      217 

patients  commonly  to  external  machinations.  The  fourth  is 
the  anccsthdic  form,  in  which  absence  of  sensibility  is  often  the 
cause  of  self-mutilation.  Lastly,  there  is  the  hallucinatory  form, 
which  obviously  needs  no  further  explanation  here.  It  is  un- 
doubtedly of  great  importance  to  bestow  scrupulous  attention 
upon  all  the  disorders  of  sensibility,  as  well  as  upon  those  of 
nutrition  and  movement,  which  occur  in  the  different  sorts  of 
insanity  ;  to  do  so  is  an  essential  part  of  the  physician's  duty  in 
studying  the  entire  natural  history  of  the  disease  ;  but  it  is  not 
possible  to  make  perversions  of  sensibility  alone  the  basis  of  a 
system  of  classification.  Such  a  classification  could  not  fail  to 
have  an  extremely  artificial  character  and  an  entirely  theoretical 
foundation. 

The  centre  of  morbid  irritation  which  gives  rise  to  secondary 
disorder  by  reflex  or  sympathetic  action  need  not  be  in  some 
distant  organ;  it  may  be  in  the  brain  itself.  A  tumour,  an 
abscess,  a  clot  of  blood,  a  cysticercus,  a  local  softening  in  the 
brain,  will  nowise  interfere  with  the  mental  operations  at  one 
time,  when  it  produces  grave  disorder  of  them  at  another  time ; 
and  it  is  not  uncommon  in  abscess  of  the  brain  for  the  symptoms 
of  mental  derangement,  when  there  are  any,  to  disappear  entirely 
for  a  time,  and  then  to  return  suddenly  in  all  their  gravity. 
When  the  motor,  sensory,  and  ideational  centres  are  not  directly 
damaged  by  the  disease,  they  can  continue  their  functions  in 
spite  of  it ;  accordingly  they  sometimes  do  so  even  when  there  is 
the  most  serious  mischief  going  on  in  the  brain ;  but  they  may 
at  any  moment  be  affected  by  a  sympathetic  or  reflex  action,  and 
a  secondary  derangement  or  abolition  of  function  may  thus 
supervene  without  warning,  the  gravest  symptoms  perhaps 
coming  and  going  in  a  surprising  manner.  Instances  now  and 
then  occur  in  which  a  sudden  loss  of  consciousness,  or  a  sudden 
incoherence,  or  sudden  mania,  or  even  sudden  death,  takes  place 
where  no  marked  premonitory  symptoms  have  indicated  grave 
local  disease  of  the  brain. 

Furthermore,  a  limited  disorder  of  the  ideational  centres,  such 
as  is  manifest  functionally  in  the  fixed  delusions  of  the  so-called 
monomaniac,  is  not  usually  without  effect  npon  the  other 
elements  in  the  supreme  centres.      So  delicately .  sympathetic 


218  PATHOLOGY  OF  MIND.  .     [chap. 

and  sensitive  as  nerve-element  is,  it  is  not  probable  that  a  centre 
of  morbid  action  will  fail  to  affect,  by  direct  or  by  reflex  action, 
neighbouring  parts  that  are  not  immediately  involved  in  the 
disease.  In  matter  of  fact  a  greater  or  less  disturbance  of  the 
tone  of  the  whole  mind  does  commonly  accompany  the  limited 
delusions  of  a  so-called  partial  insanity ;  the  condition  of  things 
is  something  like  that  which  has  already  been  described  as  the 
first  stage  of  the  affection  of  mind  by  other  causes  of  its  derange- 
ment— namely,  a  modification  of  the  mental  tone.  This  baneful 
effect  of  a  limited  local  disorder  is  not  of  course  a  case  of  meta- 
stasis, since  the  primary  disease  disappears  not,  but  a  case  of  so- 
called  sympathy,  where  the  primary  disease  continues  in  action ; 
in  other  words,  it  is  produced  by  direct  or  reflex  irritation. 
Hereafter  we  shall  have  occasion  to  describe  instances  of  the 
sudden  and  entire  transference  of  active  disorder  of  one  nervous 
centre  to  another ;  for,  as  Dr.  Darwin  long  ago  observed,  *'  in 
some  convulsive  diseases  a  delirium  or  insanity  supervenes  and 
the  convulsions  cease;  and,  conversely,  the  convulsions  shall 
supervene  and  the  delirium  cease." 

It  is  necessary  here,  as  in  the  spinal,  sensory,  and  motor 
centres,  to  distinguish  between  the  degrees  of  secondary  disorder 
to  which  a  distant  morbid  cause  may  give  rise.  The  sudden 
way  in  w^hich  extreme  mental  symptoms  appear,  and  the  equally 
sudden  way  in  which  they  disappear  sometimes,  as  in  abscess  of 
the  brain,  prove  that  extreme  derangement  may  be  what  is 
called  functional ;  for  it  is  impossible  to  suppose  that  serious 
organic  change  has  been  and  gone  in  such  cases.  Although, 
therefore,  the  functional  disorder  necessarily  implies  a  molecular 
change  of  some  kind  in  the  nervous  element,  the  change  may  be" 
assumed  to  be  one  affecting  the  polar  relations  of  the  molecules, 
such  as  the  experiments  of  Du  Bois  Eeymond  and  others  have 
proved  may  rapidly  be  induced  and  as  rapidly  disappear.  Cer- 
tainly the  induction  of  recognizable  temporary  changes  in  the 
physical  constitution  and  function  by  experiments,  warrants  the 
belief  in  similar  modifications  by  causes  which  are- not  artificial, 
but  which  are  just  as  abnormal  as  if  they  were.  If  the  modifi- 
cation of  nervous  element  be  too  great  or  too  prolonged,  it  fails 
not  to  degenerate  into  actual  nutritive  change  and  structural 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      219 

disease,  just  as  an  emotion  which  alters  a  secretion  temporarily 
may,  when  long  enduring,  lead  to  actual  nutritive  change  in  the 
organ.  The  longer  a  functional  derangement  lasts,  the  more 
danger  is  there  of  structural  disease  ;  and  when  this  serious 
change  is  once  definitely  established,  the  removal  of  the  primary 
morbid  cause  will  not  get  rid  of  an  effect  which  has  now  become 
an  independently  acting  cause. 

4  Excessive  Functional  Activity. — As  the  display  of  function 
is  the  consumption  of  matter,  it  is  obvious  that,  if  the  due  inter- 
vals of  periodical  rest  be  not  allowed  for  the  restoration  of  the 
statical  equilibrium  of  nerve-element,  degeneration  of  it  must 
take  place  as  surely  as  if  it  were  directly  injured  by  a  morbid 
poison,  or  by  a  mechanical  or  chemical  irritant.  It  is  sleep 
which  thus  knits  up  the  ravelled  structure  of  nerve-element ; 
for  during  sleep  organic  assimilation  restores,  as  statical  or 
potential,  the  power  which  has  been  expended  in  functional 
energy.  The  brain,  like  any  other  organ  of  the  body,  is  endowed 
with  a  limited  power  of  work  and  endurance  only,  a  limit  which 
cannot  be  exceeded  without  danger ;  and  its  strength  and  weak- 
ness measure  the  strength  and  weakness  of  the  mind.  The 
strongest  mind,  if  continually  overstrained,  will  inevitably  break 
down ;  one  of  the  first  symptoms  that  foreshadows  the  coming 
mischief  being  sleeplessness.  That  which  should  heal  the  breach 
is  rendered  impossible  by  the  extent  of  the  breach.  Like  Ham- 
let, according  to  Polonius's  fruitful  imagination,  the  individual 
falls  into  a  sadness,  thence  into  a  watch,  thence  into  a  lightness, 
and,  by  this  declension,  into  the  madness  wherein  he  finally 
raves.  To  provoke  repose  in  him  is  the  first  condition  of  re- 
storation ;  sound  sleep  closing  the  "  eye  of  anguish,"  and  curing 
the  "  great  breach  in  the  abused  nature  "  of  nervous  element. 

It  is,  however,  when  intellectual  activity  is  accompanied  with 
great  emotional  agitation  that  it  is  most  enervating — when  the 
mind  is  the  theatre  of  contending  passions  that  its  energy  is 
soonest  exhausted.  The  instability  of  nerve-element  which 
great  emotional  susceptibility  means  enables  us  to  understand 
how  this  destructive  effect  is  wrought.  When  an  exceedingly 
painful  event  produces  great  sorrow,  or  a  critical  event  great 
agitation,  or  an  uncertain  event  great  apprehension  and  anxiety, 


220  PATHOLOGY  OF  MIND.  [chap. 

the  mind  is  undergoing  a  passion  or  suffering ;  tliere  is  not  an 
equilibrium  between  the  internal  state  and  the  external  circum- 
stances ;  and  until  the  mind  is  able  to  react  adequately,  either 
in  consequence  of  a  fortunate  lessening  of  the  outward  pressure, 
or  by  a  recruiting  of  its  own  internal  forces,  the  passion  must 
continue — in  other  words,  the  wear  and  tear  of  nervous  element 
must  go  on.  Painful  emotion  is  in  truth  psychical  pain ;  and 
pain  here,  as  elsewhere,  is  the  outcry  of  suffering  organic  element 
— a  prayer  for  deliverance  and  rest. 

The  same  objects  or  events  notably  produce  very  different 
impressions  upon  the  mind  according  to  its  condition  at  the 
time — according  perhaps  as  something  pleasant  or  something 
unpleasant  has  just  happened.  If  there  be  a  temporary  depres- 
sion of  the  psychical  tone  by  reason  of  some  recent  misfortune, 
or  because  of  some  bodily  derangement,  then  an  event,  which 
under  better  auspices  would  have  been  indifferent,  will  rouse 
painful  emotion,  and,  calling  up  congenial  ideas  of  a  gloomy 
kind,  perpetuate  and  add  to  the  mental  suffering;  just  as 
reflex  action  that  is  provoked  or  increased  by  a  morbid  cause 
sometimes  aggravates  in  turn  the  original  disorder.  If  there 
be  a  lasting  depression  of  the  psychical  tone  by  reason  of 
some  continuing  morbid  cause,  then  every  event  is  apt  to  ag- 
gravate the  suffering,  being  seen  through  the  distorting  medium 
of  the  sad  feeling ;  and  a  particularly  unfavourable  event,  or  a 
succession  of  painful  events,  may  be  enough  to  cause  actual 
derangement  of  mind.  After  a  piece  of  good  news,  or  after  a 
man  has  just  drunk  a  glass  of  wine,  or  taken  a  dose  of  opium, 
the  psychical  tone  is  so  much  animated  that  there  is  a  direct 
and  adequate  reaction  to  an  unfavourable  impression,  and  he  will 
not  suffer;  wherefore  comes  the  temptation  to  have  recourse  in 
time  of  trouble  to  stimulants  like  opium  and  alcohol.  Herein 
the  supreme  centres  of  thought  do  not  differ  from  the  inferior 
nervous  centres ;  when  the  spinal  centres  are  exhausted,  ex- 
citability is  increased,  a  state  of  irritable  weakness  being  pro- 
duced, and  an  impression,  which  under  better  auspices  would 
have  had  no  bad  effect,  gives  rise  to  the  degenerate  activity  of 
spasmodic  movements :  an  explosion  not  unlike  that  which  in 
the  higher  centre  is  manifest  as  emotion,  or  as  an  ebullition  of 


v.]        THE  CAUSATION  AND  PKEVENTION  OF  INSANITY.      221 

passion,  since  emotional  outbursts  may  justly  be  considered  to  be 
of  the  nature  of  molecular  explosions  or  commotions.  Excess  is, 
however,  a  relative  term ;  and  a  stress  of  function  which  would 
be  no  more  than  normal  to  a  powerful  and  well-ordered  mind, 
and  conducive  to  its  health,  might  be  fatal  to  the  stability  of  a 
feeble  and  ill-regulated  mind  in  which  feeling  habitually  over- 
swayed  reason,  or  even  to  that  of  a  strong  mind  which  was 
temporarily  prostrate.  Thus  it  is  that  in  pursuing  inquiries 
into  the  causation  of  insanity  in  any  case  it  is  not  enough  to 
examine  only  the  concurrence  and  succession  of  influences  to 
which  the  individual  has  been  exposed,  but  it  is  necessary  also 
to  look  to  the  capacity  he  had  of  bearing  them  at  the  time. 

In  weighing  the  operation  of  moral  causes  to  produce  insanity 
we  find  too  their  effect  to  be  in  proportion  to  the  suddenness 
and  intensity  with  which  they  strike  as  well  as  to  their  actual 
power;  for  a  sudden  shock,  like  a  violently  imposed  burden,  will 
break  down  the  strength  when  a  heavier  burden  would  have 
been  borne  had  it  been  adjusted  gradually.  The  violence  of  the 
shock  is  determined  by  the  suddenness  and  weight  of  the  moral 
impression — by  the  momentum,  in  fact,  with  which  it  strikes  the 
mind.  In  the  same  way,  the  lavish  expenditure  of  a  great  deal 
of  energy  in  a  short  time,  such  as  takes  place  in  a  financial 
crisis,  in  a  political  revolution,  in  a  religious  revival,  and  on 
similar  occasions  of  agitation  of  feeling  and  exaltation  of  energy, 
when  the  whole  power  of  the  mind  is  stimulated  unduly  and 
used  unsparingly  within  a  brief  period,  will  be  followed  by  a 
deep  exhaustion  that  may  end  in  disease  ;  notwithstanding  that 
the  same  amount  of  energy  might  have  been  used  without  grave 
danger  if  its  expenditure  had  been  prudently  regulated.  A  per- 
son should  deal  with  his  vital  force  very  much  as  he  deals  with 
his  linances,  and  live  on  the  interest  of.  his  capital ;  for  should 
he  make  demands  on  the  capital,  whether  in  a  large  sum  to  meet 
an  occasional  emergency,  or  in  accumulating  dribblets  to  meet 
daily  slight  excesses  of  expenditure  over  income,  he  must  be 
bankrupt  in  the  end. 

I  take  the  actual  mode  of  operation  of  a  moral  cause  to  be 
just  as  physical  as  the  operation  of  a  stroke  of  lightning,  which, 
like  it,  may  produce  paralysis  or  sudden  death,  and  perhaps  in 


222  rATHOLOGY  OF  MIND.  [cnAP. 

tlie  same  way  ;  and  I  look  upon  tlie  derangement  of  mind  which 
grief  causes  as  just  as  much  a  pliysical  result  brought  about  by 
physical  causes  as  is  the  delirium   of  starvation.     When  any 
great  passion  causes  all  the  physical  and  moral  troubles  which 
it  will  cause,  what  I  conceive  to  happen  is  that  a  physical  im- 
pression made  upon  the  sense  of  sight  or  of  hearing  is  propa- 
gated along  a  physical  path  to  the  brain,  and  arouses  a  physical 
commotion  in  its  molecules ;  that  from  this  centre  of  commotion 
the  liberated  energy  is  propagated  by  physical  paths  to  other 
parts  of  the  brain;  and  that  it  is  finally  discharged  outwardly 
through  proper  physical  paths,  either  in  movements  or  in  modi- 
fications of  secretion  and  nutrition.     The  passion  that  is  felt  is 
the  subjective  side  of  the  cerebral  commotion — its  motion  out 
from  the  physical  basis,  as  it  were  (e-motion),  into  consciousness 
— and  it  is  only  felt  as  it  is  felt  by  virtue  of  the  constitution  of 
the  cerebral  centres,  into  which  have  been  wrought  the  social 
sympathies  of  successive  ages    of  men  :   inheriting   the  accu- 
mulated results  of  the  experiences  of  countless  generations,  the 
centres  manifest  the  kind  of  function  which  is  embodied  in 
their  structure.     The  molecular  commotion  of  the  structure  is 
the  liberation  of  the  function:   if  forefathers  have  habitually 
felt,  and  thought,  and   done  unwisely,  tlie    structure   will   be 
unstable  and  its  function  irregular. 

The  foregoing  reflections  show  that,  from  a  pathological  point 
of  view,  the  so-called  moral  causes  of  insanity  fall  fitly  under 
the  head  of  excessive  stimulation  or  excessive  functioiml  action  : 
the  mind  is  subject  to  a  stress  beyond  that  which  it  is  able 
to  bear,  either  because  of  the  weight  of  the  pressure  from  with- 
out or  because  of  the  weakness  within.  Of  necessity  the 
depressing  passions  are  the  most  efficient  causes  of  exhaustion 
and  consequent  disease :  grief,  religious  anxiety,  loss  of  fortune, 
disappointed  affection  or  ambition,  the  wounds  of  an  exaggerated 
self-love,  and,  above  all  perhaps,  the  painful  feeling  of  being 
unequal  to  responsibilities,  or  other  like  conditions  of  mental 
agitation  and  suffering,  are  most  apt  to  reach  a  violence  of  action 
which  issues  in  the  overthrow  of  the  mental  equilibrium.  Great 
intellectual  activity,  when  unaccompanied  by  emotion,  does  not 
often  lead  to  insanity ;  it  is  when  the  feelings  are  anxiously 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      223 

encrn^-ed  that  the  mind  is  most  moved  and  its  stability  most 
endangered :  on  the  stage  of  mind  as  on  the  world's  stage  the 
great  catastrophes  are  produced  by  passion.  Moreover,  when  an 
individual  has,  by  a  long  concentration  of  thought,  interest,  and 
desire  upon  a  certain  aim,  grown  into  definite  relations  with 
regard  to  it,  and  made  it,  as  it  were,  a  part  of  the  inner  life,  a 
sudden  and  entire  change,  shattering  long-cherished  hopes,  is 
not  unlikely  to  produce  insanity ;  for  nothing  is  more  fraught 
with  danger  to  the  stability  of  the  mind  than  a  sudden  great 
change  in  external  circumstances,  without  the  inner  life  having 
been  gradually  adapted  thereto.  Thence  it  comes  that  a  great 
exaltation  of  fortune,  as  well  as  a  great  affliction,  rarely  fails  to 
disturb  for  a  time  the  strongest  head,  and  sometimes  quite  over- 
turns a  weak  one ;  the  former  succeeding  after  a  time  in 
establishing  an  equilibrium  between  itself  and  its  new  sur- 
roundings which  the  latter  cannot  do.  When  exhausting 
passion  does  not  act  directly  as  the  cause  of  a  sudden  outbreak 
of  insanity,  it  may  still  act  banefully  by  its  long-continued 
depressing  influence  on  the  organic  life,  and  thus  in  the  end 
lead  to  mental  derangement. 

o 

Automatic  function  I  have  shown  to  mean  stored-up  power 
— abstract  of  former  function — inherent  as  original  faculty  of 
the  individual  or  acquired  by  his  own  cultivation  and  exercise. 
Whether  then  he  shall  be  equal  to  the  work  and  responsibilities 
of  his  position  in  life  will  depend,  first  and  mainly,  upon  his 
native  powders  of  mind,  and,  secondly,  upon  the  special  training 
which  he  has  had  to  fit  him  for  Avhat  he  has  to  do :  either  will 
supplement  in  large  measure  the  deficiencies  of  the  other. 
Accustomed  duties  are  discharged  with  ease,  while  new  duties 
exact  much  expenditure  of  anxious  energy,  because  the  special 
automatic  power  has  to  be  built  up  by  laborious  training  in 
accordance  with  a  law  of  structuralization  of  function.  It  is 
easy  then  to  see  why  the  assumption  of  important  new  func- 
tions for  which  the  individual  is  not  fitted  by  original  power  or 
by  previous  special  training  will  be  especially  trying  to  his 
mental  stability  :  there  is  not  only  a  large  call  upon  cerebral 
energy  to  make  the  adaptation,  but  there  is  the  exhausting 
emotion   produced   by  the  nervous  apprehension  of  unfitness. 


224  PATHOLOGY  OF  MIND.  [chap. 

Here  is  made  manifest  the  wisdom  of  a  sound  general  culture 
by  which  the  mind  is  made  a  fitting  instrument  to  adapt  itself 
easily  to  any  form  of  special  activity ;  if  a  person  make  it  his 
pains  to  have  good  habit  of  judgment,  good  habit  of  thought, 
good  habit  of  feeling,  good  habit  of  doing,  by  continual  practice 
of  good  judgment,  good  thought,  good  feeling  and  good  doing, 
so  that  he  needs  not  on  each  new  occasion  to  consider  minutely, 
to  feel  apprehensively,  to  do  anxiously,  but  can  judge,  think, 
feel,  and  do  quickly  and,  as  it  were,  instinctively,  he  will  have 
an  excellent  stability  of  nature  to  enable  him  to  cope  with  the 
duties  and  trials  of  his  life  in  whatsoever  position  he  may  be 
placed. 

Another  class  of  moral  causes  of  insanity  acts  quite  differently 
from  the  depressing  causes  which  I  have  just  considered :  these 
are  the  elated  passions.  It  is  not  often  that  men  become  insane, 
though  they  sometimes  die,  from  the  commotion  which  excess 
of  joy  occasions  ;  and  when  one  of  the  expansive  passions,  as 
ambition,  religious  exaltation,  overweening  vanity  in  any  of  its 
Protean  forms,  leads  gradually  to  mental  derangement,  it  does 
not,  like  a  painful  passion,  act  directly  as  the  cause  of  an  out- 
break, nor  indirectly  by  producing  organic  disorder  and  sub- 
sequent insanity ;  its  morbid  effects  are  the  exaggerated  develop- 
ment of  a  certain  peculiarity  or  vice  of  character — the  morbid 
hypertrophy,  so  to  speak,  of  a  bad  quality  of  character.  Each 
indulgence  in  passion,  caprice,  even  oddity  or  perversity,  notably 
makes  easier  the  next  step  in  the  same  direction :  what  a  person 
sows  hourly,  good  or  ill,  that  shall  he  reap  :  the  hypertrophy  of 
passion  and  prejudice  is  the  atrophy  of  principle  and  judgment. 
In  the  Edinburgh  asylum  was  a  blacksmith  who  imagined  him- 
self to  be  King  of  Scotland ;  his  daughter,  who  was  an  inmate 
of  the  same  asylum,  believed  herself  to  be  a  royal  princess  ; 
not  because  she  shared  her  father's  delusion,  for  she  perceived 
clearly  enough  that  he,  poor  man,  was  only  a  blacksmith  who 
had  an  insane  delusion,  as  he  also  on  his  part  recognized  that  his 
daughter  was  not  a  princess,  but  a  lunatic.  The  daughter's  delu- 
sion then  was  not  a  specific  inheritance  by  her  nor  had  she  got 
it  by  logical  inference  ;  it  was  probably  the  morbid  outgrowth 
of  a  fundamental  quality  of  character  common  to  her  and  to  her 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      225 

father.  It  is  tliis  development  of  insanity  as  the  morbid  growth 
of  a  disposition  which  often  makes  it  hard  to  say  where  disease 
begins,  and  harder  still  to  cure  it.  When  a  depressing  passion 
due  to  external  causes  overthrows  the  mind,  the  derangement 
is,  so  to  speak,  accidental  or  extrinsic,  and  the  delusion  which  is 
the  outgrowth  of  it  fades  and  finally  vanishes  as  the  emotional 
tone  improves  and  mental  power  is  restored ;  when  an  egoistic 
passion  grows  into  a  morbid  delusion,  the  derangement  is 
essential  or  intrinsic,  and  the  delusion  which  is  its  essential 
outcome  cannot  be  got  rid  of  except  by  rooting  out  the  dis- 
position :  it  is  not  an  instance  of  excessive  functional  activity, 
but  an  instance  of  morbid  development. 

A  fatal  drain  upon  the  vitality  of  the  higher  nervous  centres 
is  in  certain  cases  the  consequence  of  the  excessive  exercise  of 
a  physical  function — an  excessive  sexual  indulgence,  or  a  habit 
of  self-abuse.  Nothing  is  more  plain  than  that  either  of  these 
causes  will  produce  an  enervation  of  nerve  element  which,  if 
the  exhausting  vice  be  continued,  passes  by  a  further  declension 
into  degeneration  and  actual  destruction  thereof  The  flying 
pains  and  the  startings  of  the  limbs,  which  follow  an  occasional 
sexual  excess,  are  signs  of  instability  of  nerve  element  in  the 
spinal  centres,  which,  if  the  cause  is  in  frequent  operation,  may 
end  in  softening  of  the  cord  and  consequent  paralysis.  Nor  do 
the  supreme  centres  always  escape ;  the  habit  of  self-abuse 
notably  gives  rise  to  a  particular  and  disagreeable  form  of 
insanity,  characterized  by  intense  self-feeling  and  conceit,  loss 
of  mental  energy,  hypochondriacal  brooding,  pitiful  vacillation, 
extreme  perversion  of  feeling,  and  corresponding  derangement 
of  thought,  in  the  earlier  stages;  and,  later,  by  failure  of  in- 
telligence, nocturnal  hallucinations  of  a  painful  character,  and 
suicidal  or  homicidal  propensities.  The  mental  symptoms  of 
general  paralysis — a  disease  often  caused  by  sexual  excess — 
betray  a  degenerate  condition  of  nerve  element  in  the  higher 
centres,  which  is  the  counterpart  of  that  which  in  the  lower 
centres  is  the  cause  of  the  loss  of  co-ordination  of  movement 
and  of  more  or  less  spasm  or  paralysis.  The  great  emotional 
exaltation,  the  busy  excitability  with  feebleness,  of  the  general 
paralytic,  no  less  than  the  extravagance  of  his  ideas,  mark  a 


226  PATHOLOGY  OF  MIND.  [chap. 

degeneration  of  tlie  ideational  centres ;  there  is  accordingly  an 
inability  to  co-ordinate  and  perform  his  ideas  successfully  even 
before  there  are  actual  delusions,  just  as  there  is  an  inability 
to  perforin  movements  successfully  in  the  later  stages  of  the 
disease,  because  the  spinal  centres  are  similarly  affected.  It  is 
not  usual,  however,  for  sexual  excesses  to  cause  other  sorts 
of  insanity  than  general  paralysis ;  their  tendency  is  to  produce 
epilepsy  or  some  form  of  paralysis.  Self-abuse  is  a  cause  of 
insanity  which  appears  to  be  more  frequent  or  more  effective 
in  men  than  in  women,  and  in  them  to  require  usually  the 
co-operation  of  a  particular  neurosis.  Apart  from  all  question 
whether  the  vice  be  so  common  among  women,  they  bear  its 
effects,  as  they  do  sexual  excesses,  better  than  men.  On  the 
other  hand,  privation  of  sexual  function  is  more  injurious  to 
women  than  to  men. 

5.  Injuries  and  Diseases  of  the  Brain  and  Nervous  System  not 
necessarily,  hut  occasionally,  producing  Insanity. — Injuries  of  the 
head,  when  not  followed  by  immediate  ill  consequences,  may 
nevertheless  lead  to  mental  derangement,  through  the  degenera- 
tive changes  which  they  ultimately  set  going  ia  the  cortical 
layers  of  the  hemispheres.^  The  changes  are  often  of  a  slow 
and  insidious  character,  going  on  for  years  perhaps  before  they 
produce  very  marked  mental  effects.  At  first  there  is  nothing 
more  noticed  than  a  change  of  temper  and  disposition  in  the 
person  ;  he  is  prone  to  outbursts  of  anger  on  trivial  occasions,  or 
to  excesses  foreign  to  his  former  character ;  a  moderate  quantity 

1  Professor  Sclilager,  of  Vienna  {Zeitschrlft  der  h.  h.  GcseUschaft  der 
Aerzie  zu  Wien,  xiii.  1857),  hns  made  some  valuable  researclies  regarding 
mental  disorder  following  injury  of  the  brain.  Out  of  500  insane,  Le 
traced  mental  disorder  to  injury  of  the  brain  in  49  (42  men  and  7  women). 
In  21  cases  there  h.id  been  complete  unconsciousness  after  the  accident  ; 
in  16,  some  insensibility  and  confusion  of  ideas  ;  in  12,  simple  dull  head- 
ache. In  19  cases  the  mental  disorder  came  on  in  the  course  of  a  year 
after  the  injury,  but  not  till  much  later  in  many  others,  and  in  4  cases  after 
more  than  ten  years.  In  most  of  the  cases  the  patients  were  disposed  to  con- 
gestion of  the  brain,  excitement  and  great  emotional  disturbance,  from  the 
time  of  the  injury,  on  taking  a  moderate  quantity  of  spirituous  liquor ; 
frequently  there  was  singing  in  the  ears,  or  difficulty  of  hearing,  or  hal- 
lucination; and  vei-y  conmionly  the  disposition  was  changed,  and  the 
patient  was  prone  to  outbursts  of  anger  or  of  excesses.  Tlie  prognosis 
was  very  unfavourable  ;  the  issue  in  7  cases  was  dementia  with  paralysis, 
wliilc  10  went  on  to  death  from  the  progress  of  tho  brain  disease. 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      227 

of  alcohol  produces  an  extraordinary  excitement,  making  him 
perhaps  not  drunk,  but  actually  mad  for  the  time  being,  so  that 
he  may  get  into  trouble  for  assault  or  other  breach  of  the  law. 
Years  sometimes  pass  before  graver  symptoms  show  themselves. 
Dr.  Skae  mentions  the  case  of  a  woman  who,  having  suffered  a 
fracture  of  the  skull,  evinced  a  change  in  temper  and  disposition 
afterwards  and  some  other  symptoms  which  were  referred  to  the 
accident,  and  who,  after  twenty  years,  became  insane  and  violent.^ 
An  outbreak  of  acute  mania,  or  an  epileptic  lit  followed  by 
mania,  may  be  the  climax  of  a  long  series  of  slow  changes,  and 
be  followed  by  gloomy  depression  with  suspicious  delusions  and 
impulsive  violence,  and  by  increasing  dementia. 

A  most  interesting  case  has  been  put  on  record  by  Dr.  Holland 
Skae.^  A  collier  was  struck  insensible  by  a  mass  of  falling  coal 
which  fractured  his  skull  about  three  inches  above  the  outer  angle 
of  the  left  eyelid.  After  four  days  he  regained  consciousness,  and 
in  a  few  weeks  was  able  to  resume  work  in  the  pit.  Soon  after 
doing  so  a  change  was  noticed  in  his  character  and  behaviour : 
instead  of  being,  as  formerly,  cheerful,  sociable,  good-natured, 
gentle  to  wife  and  children,  he  was  mood)'',  taciturn,  and  irritable, 
repelling  the  attentions  of  his  wife's  and  the  demonstrations  of 
his  children's  affection.  Gradually  he  got  worse  ;  he  was  often 
excited,  used  threatening  language  to  his  wife,  children,  and 
neighbours ;  finally  he  became  maniacal  and  violent,  attempted 
to  take  his  own  life  and  his  wife's  life,  and  had  a  succession  of 
epileptic  fits.  He  was  sent  to  an  asylum.  After  he  had  been 
tliere  two  months  he  was  trephined,  a  depressed  portion  of  bone 
at  the  place  where  he  had  been  struck  being  removed.  Soon 
after  the  operation  he  began  to  mend,  returning  gradually  to  his 
natural  self;  in  the  end  he  became  a  cheerful,  active,  and  oblig- 
ing person,  with  all  his  family  affections  restored.  He  was  able 
to  support  his  wife  and  family  by  his  labour  when  he  left  the 
asylum,  and  four  years  after  his  discharge  was  still  quite  sane. 

Insolation  notably  acts  injuriously  on  the  supreme  cerebral 

centres,  either  by  causing,  as  some  imagine,   acute  hj-per^emia 

and   serous  effusion,  or,  as  is  more  probable,  over-stimulation 

^  Report  of  the  Morning  side  Asylum,  1867. 
2  Journal  of  Mental  Science,  vol.  xix.,  p.  552. 


228  PATHOLOGY  OF  MIND.  [chap. 

and  consequent  exhaustion  of  nerve  element.  In  most  instances 
of  the  kind  there  is  reason  to  think  that  an  imprudent  indul- 
gence in  alcoholic  stimulants  has  co-operated. 

Hysteria  undoubtedly  slides  mto  insanity  in  some  instances. 
There  seem  to  be  two  varieties  of  mental  derangement  present- 
ing hysterical  characteis,  which  may,  however,  pass  into  one 
another.  An  acute  attack  of  maniacal  excitement,  with  great 
restlessness;  perverseness  of  conduct,  which  is  pretty  coherent 
and  wilful;  loud  and  rapid  conversation,  sometimes  blasphemous 
or  obscene  ;  laughing,  singing,  or  rhyming— may  follow  the 
ordinary  hysterical  convulsions,  or  may  occur  instead  of  them. 
Or  the  ordinary  hysterical  symptoms  may  pass  by  degrees  into 
a  chronic  insanity :  the  patient  loses  more  and  more  energy  and 
self-control;  becomes  more  fanciful  about  her  morbid  sensations, 
to  which  she  gives  exaggerated  attentions ;  is  extremely  egotistic, 
wilful,  and  exacting;  gets  more  and  more  impatient  of  all  advice 
or  interference,  and  indifferent  to  social  obligations ;  and  often- 
times shows  a  singular  aptness  for  deceit.  The  body  becomes 
anaemic  and  emaciated,  and  there  are  usually  irregularities  of 
menstruation.  An  erotic  element  is  sometimes  evinced  in  the 
manner  and  thoughts ;  and  occasionally  ecstatic  or  quasi-cata- 
leptic states  occur.  The  symptoms  are  often  worse  at  the 
menstrual  periods. 

Under  the  head  of  nervous  diseases  which  may  become  occa- 
sions of  insanity  must  be  placed  chorea  and  epilepsy,  although 
we  know  not  yet  what  are  their  exact  seats  in  the  nervous 
system.  Chorea  in  the  adult  is  not  unapt  to  terminate  in  mental 
disorder ;  but  it  is  not  at  all  apt  to  do  so  in  the  child,  although 
some  dulness  and  weakness  of  mind  often  accompany  it. 
Different  sorts  of  insanity  are  met  with  in  connection  with 
epilepsy.  When  the  fits  have  recurred  frequently,  and  the 
disease  has  continued  for  a  long  time,  it  undoubtedly  produces 
loss  of  memory,  failure  of  mental  power,  and  ultimately  com- 
plete dementia.  That  is  one  form.  Secondly,  a  succession  of 
severe  fits  may  be  followed  by  a  condition  of  acute  dementia 
which  lasts  for  a  short  time,  or  by  an  acute,  violent,  and  most 
dangerous  mania,  which  usually  passes  away  in  a  few  days. 
^ot  only  may  acute  mania  thus  follow  epilepsy,  but  an  attack 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      229 

of  acute  transitory  mania — a  true  mania  transitoria — may  take 
the  place  of  the  epileptic  paroxysm,  being  truly  a  masked 
epilepsy.  Some  writers  maintain,  however,  that  in  these  cases 
a  brief  attack  of  epileptic  vertigo  or  petit  mal  has  passed  un- 
observed. Lastly,  in  some  cases  a  profound  moral  disturbance 
— an  irxitability,  moroseness,  and  perversion  of  character,  lasting 
for  months,  with  periodical  exacerbations  in  which  vicious  or 
criminal  acts  may  be  perpetrated — precedes  the  appearance  of 
the  regular  epileptic  fits,  which  then  throw  light  upon  the 
liitherto  unaccountable  moral  perversion.  It  is  another  phase 
of  a  kind  of  abortive  or  undeveloped  epilepsy. 

Here  I  may  fitly  take  occasion  to  adduce  certain  observations 
wdth  resfard  to  the  strikincj  manner  in  which  diseorsed  action  of 
one  nervous  centre  is  sometimes  transferred  suddenly  to  another  : 
a  fact  which,  though  it  has  lately  attracted  new  attention,  was 
long  since  noticed  and  commented  on  by  Dr.  Darwin : — "  In 
some  convulsive  diseases,"  he  writes,  "  a  delirium  or  insanity 
supervenes,  and  the  convulsions  cease ;  and,  conversely,  the 
convulsions  shall  supervene,  and  the  delirium  cease.  Of  this 
I  have  been  a  witness  many  times  a  day  in  the  paroxysms  of 
violent  epileptics ;  which  evinces  that  one  kind  of  delirium  is  a 
convulsion  of  the  organs  of  sense,  and  that  our  ideas  are  the 
motions  of  these  organs."  Miss  G.,  one  of  his  patients,  a  fair 
young  lady  with  light  eyes  and  hair,  was  seized  with  most 
violent  convulsions  of  her  limbs,  with  outrageous  hiccough,  and 
most  vehement  efforts  to  vomit.  After  nearly  an  hour  had 
elapsed  this  tragedy  ceased,  and  a  calm,  talkative  delirium 
supervened  for  about  another  hour,  and  these  relieved  each 
other  at  intervals  during  the  greater  part  of  three  or  four  days. 
"  After  having  carefully  considered  this  disease,*'  he  says,  "  I 
thought  the  convulsions  of  her  ideas  less  dangerous  than  those 
of  her  muscles  ;  "  and  thereupon  he  adopted  such  treatment  as 
resulted  in  the  young  lady's  recovery.  In  another  case  which 
came  under  his  observation,  "  these  periods  of  convulsions,  first 
of  the  muscles  and  then  of  the  ideas,  returned  twice  a  day  for 
several  weeks."  "  Mrs.  C,"  again,  "  was  seized  every  day,  about 
the  same  hour,  with  violent  pains  in  the  right  side  of  her  bowels, 
about   the  situation  of    the   lower   edge  of  the  liver,  without 


230  PATHOLOGY  OF  MIND.  [chap. 

fever,  which  increased  for  an  hour  or  two,  till  it  became  totally 
intolerable.  After  violent  screaming  she  fell  into  convulsions, 
which  terminated  sometimes  in  fainting,  with  or  without  stertor, 
as  in  common  epilepsy;  at  other  times  a  temporary  insanity  super- 
vened, which  continued  about  half  an  hour,  and  the  fit  ceased."^ 

Brodie  relates   the   case   of  a  lady  who  suffered  for  a  year 
from  persistent  spasmodic  contraction  of  the  sterno-cleido-mas- 
toid ;  suddenly  it  ceased,  and  she  fell  into  a  melancholy ;  this 
lasted   a   year;   after  which  she  recovered  mentally,    but   the 
cramp  of  the  muscle  returned,  and  lasted  for  many  years.     In 
another  case  mentioned  by  him,  a  neuralgic  condition  of  the 
vertebral  column  alternated  with  true  insanity.     Dr.  Burrows 
met  with  similar  cases :  one  "  in  a  very  eloquent  divine,  who 
was  always  maniacal  when  free  from  pains  in  the  spine,  and 
sane  when  the  pains  returned  to  that  site."  ^     A  patient  in  St. 
Mary's  Hospital,  who  was  convalescent  from  typhoid  fever,  had 
hypersesthesia  of  the  legs,  which  ceased  when  maniacal  delirium 
set  in,  but  returned  with  great  intensity  when  the  delirium  sub- 
sided.^    Without  doubt  the  delirium,  which  was  the  outcome  of 
a  disorder  of  the  supreme  centres,  was  the  equivalent  of  the 
hyperesthesia  which  was  the  outcome  of  disorder  of  the  sensory 
centres.     Whether  there  is  an  actual  transference  of  the  morbid 
action  from  one  set  of  nerve-centres  to  another  in  these  cases ; 
or  whether  an  independently  lighted  disorder  in  the  latter  over- 
powers and  suspends  the  disorder  of  the  former,  as   a  greater 
pain  inhibits  a  less  pain,  or  as  an  attack  of  mania  sometimes 
suspends  an  asthma  or  a  chronic  discharge,  it  is  not  easy  to  say. 
We  must  accept  the  fact,  whatever  may  be  its  exact  pathological 
explanation. 

One  of  the  most  frequent  observations  which  the  clinical 
observer  has  to  make  in  respect  of  tumours,  abscess,  cysticercus, 
and  such  gross  products  of  cerebral  disease,  is  the  absence  of 
symptoms  of  mental  disturbance.  The  fact  at  first  seems 
striking,  because  the  presence  of  so  much  disease  in  its  midst 
might  be  thought  incompatible  with  the  undisturbed  function  of 
the  brain  as  the  organ  of  mind.     After  giving  a  careful  report 

1  Zoonomia,  vol,  i.  pp.  25,  26.  2  Commentaries  on  Insanity. 

3  Dr   Haiidfield  Jones  in  St.  George's  Uospital  EejJort,  vol.  ii.  1867. 


v.]       THE   CAUSATION  AND  PREVENTION  OF  INSANITY.       231 

of  ten  cases  of  tumour  of  the  brain,  Dr.  Ogle  calls  attention  to 
tlie  fact  that,  "  in  no  case  was  there  during  life  anything  of  the 
nature  of  mental  imbecility,  or  any  symptom  of  the  various 
phases  or  forms  of  insanity."  ^  An  examination  of  what  was 
found  after  death  in  these  cases  furnishes  a  sufficient  reason  for 
the  non-affection  of  the  intelligence.  In  none  of  the  ten  was 
there  any  observed  implication  of  the  nervous  centres  of  intel- 
ligence by  the  morbid  action;  the  mischief  was  more  or  less 
central,  and  the  hemispherical  ganglia  continued  their  functions, 
as  they  well  might,  in  spite  of  it.  If  there  is  one  thing  which 
pathological  observation  plainly  teaches,  it  is  the  slight  irrita- 
bility of  the  adult  brain;  the  gradual  growth  of  a  tumour 
allows  the  brain  to  accommodate  itself  to  the  new  conditions ; 
and  a  closely  adjacent  nervous  centre  may  be  entirely  undis- 
turbed in  function  until  the  morbid  action  actually  encroaches 
upon  it.  Not  disease  in  the  interior  of  the  brain,  but  disease  of 
the  membranes  covering  it  and  containing  the  blood-vessels 
which  go  to  the  convolutions,  is  most  likely  to  produce  disorder 
of  the  intelligence ;  in  the  latter  case  it  lies  close  to  the  delicate 
centres  of  intelligence,  and  seriously  interferes  with  their  supply 
of  blood.  Whatever  be  the  explanation,  there  can  be  no  doubt 
of  the  fact  that  a  large  tumour  may  exist  in  the  brain,  or  that 
a  considerable  amount  of  the  brain-substance  may  soften  and 
undergo'  purulent  degeneration — the  pus  even  becoming  incap- 
suled — without  the  presence  of  a  single  symptom  to  lead  us  to 
suspect  disease  in  the  brain.^  It  has  even  happened  that  a 
patient  in  hospital,  who  has  complained  only  of  langour,  general 
debility,  and  inability  to  exert  himself,  has  been  suspected  of 
feigning  and  accused  of  indolence  because  there  were  no  marked 
symptoms  of  disease,  wdien  a  sudden  and  quick  death  has 
proved  at  the  same  time  the  existence  of  an  abscess  of  the 
brain  and  the  injustice  done  to  the  sufferer.^ 

^  Journal  of  Menial  Science,  July  18G4  :  Cases  of  Primary  Carcinoma  of 
the  Brain. 

^  For  examples  of  extensive  injury  to  the  brain,  without  mental  dis- 
turbance, see  a  paper  by  Dr.  Ferriar  in  the  first  vohime  of  the  Memoirs  of 
the  Literary  and  Philosojjhical  Society  of  Manclicster. 

3  TJeber  GeJiiniahscesse,  von  Prof.  Dr.  Lebert,  Virchow's  ArcJa'v,  vol.  x. 
1856. 

11 


232  PATHOLOGY  OF  MIND.  [•  iiap. 

Certainly  it  sometimes  happens  that  mental  disturbance  goes 
along  with  disease  in  the  brain,  even  though  the  mischief  is 
quite  central ;  in  that  case  we  must  think  that  the  disease  acts 
as  a  centre  of  irritation,  and  that  the  mind-centres  are  affected 
secondarily;  the  disturbing  action  being  either  directly  upon  the 
nerve  elements,  or  indirectly  upon  them  through  direct  vaso- 
motor commotions.  Two  things  will  often  be  observed  then 
with  regard  to  the  mental  symptoms : — (1)  that  they  are  inter- 
mittent, so  that  they  may  disappear  altogether  for  a  while  ;  and 
(2)  that  they  have  the  character  either  of  an  incoherent 
delirium,  or  of  greater  or  less  mental  imbecility. 

(1)  The  entire  disappearance  of  all  symptoms  of  mental  dis- 
order for  a  time  is  evidence  that  they  are  not  due  to  organic 
structural  change  in  the  nervous  centres  which  directly  minister 
to  mind ;  for,  if  such  change  existed,  the  recovery  could  not  be 
so  sudden  and  complete.  But  if  the  disturbance  of  the  cortical 
cells  is  secondary,  being  a  reflex  effect  of  the  primary  morbid 
action  that  is  going  on  in  the  neighbourhood,  it  is  easy  to 
conceive  that  it  may  come  and  go  suddenly,  just  as  epileptiform 
convulsions,  similarly  excited,  notably  do.  This  is  perhaps  a 
more  probable  explanation  of  the  transitory  disorder  than  the 
supposition  of  vascular  disturbances  which  come  and  go,  albeit 
these  may  be  brought  about  by  the  morbid  irritation,  and  no 
doubt  play  their  part  sometimes  in  producing  the  mental  dis- 
order. "Why  a  reflex  pathological  effect  is  produced  in  one  case 
and  not  in  another,  or  why  it  is  not  permanent  when  once  pro- 
duced, we  can  no  more  say  than  we  can  say  why  an  eccentric  irri- 
tation should  sometimes  give  rise  to  convulsions  or  paralysis, 
and  sometimes  not.  "  What  reason,"  asks  Dr.  "Whytt,  "  can  be 
given  why  sometimes,  after  cutting  off  an  arm  or  a  leg,  those 
muscles  which  raise  the  lower  jaw  should  be  affected  with  a 
spasm,  rather  than  other  muscles  ?  " 

(2)  Not  less  consonant  with  the  interpretation  of  the  mental 
disorder  as  a  reflex  effect  is  the  character  of  it ;  for  it  is  manifest 
mainly  and  mostly  either  in  (a)  great  mental  torpor  or  imbe- 
cility, deepening  into  blank  mindlessness  in  the  worst  cases ;  or 
(b)  in  delirium.  That  we  do  not  usually  meet  with  the  recog- 
nized forms  of  insanity  is  a  fact  of  some  interest  and  importance ; 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      233 

indicating,  as  it  does,  tlie  existence  of  different  morbid  condi- 
tions from  those  of  true  insanity.  A  systematized  mania  or 
melancholia  represents  a  certain  organized  result  of  abnormal 
character,  a  definite  morbid  action — the  organization,  if  you  will, 
of  disorder;  the  incoherent  delirium,  or  the  mental  imbecility,] 
with  which  we  have  now  to  do,  indicates,  on  the  other  hand,  a 
general  disturbance  of  the  supreme  centres  of  intelligence,  with- 
out any  systematization  of  the  morbid  action.  Hence,  though 
the  delirium  may  be  active,  it  is  commonly  extremely  inco- 
herent, exhibiting  an  entire  absence  of  co-ordination  :  it  suggests 
an  agitation  of  the  ganglionic  centres  of  the  hemispheres  in 
consequence  of  an  irritation  from  without.  So  also  with  regard 
to  the  imbecility  when  the  mental  disturbance  has  that  form :  it 
is  a  general  weakness  without  any  definite  character,  wanting 
the  wrecks  of  systematic  delusions  which  are  usually  met  with 
in  the  dementia  following  mania  or  melancholia.  I  much  doubt, 
however,  whether  it  is  possible  ever  to  diagnose  the  disease 
satisfactorily  by  its  mental  symptoms  only :  we  must  look  rather 
to  such  symptoms  as  intense  paroxysmal  headaches,  giddiness, 
affections  of  one  or  other  of  the  special  senses,  loss  of  power  in 
the  muscles  of  the  eye  or  of  speech,  optic  neuritis,  and  finally 
epileptiform  or  apoplectiform  attacks,  and  coma. 

When  the  local  disease  directly  implicates  the  supreme  centres 
of  intelligence,  there  may  be  extreme  mental  disorder,  or  there 
may  not.  When  there  is  mental  disorder  it  is  not  a  little 
remarkable  how  capriciously  intermittent  the  symptoms  some- 
times are ;  in  fact,  so  strangely  may  they  come  and  go,  that  one 
runs  no  little  risk  of  suspecting  a  patient  of  feigning  them.  At 
one  time  he  will  assert  that  he  is  blind,  or  that  he  is  deaf,  or 
that  he  cannot  walk,  when  it  is  plain  at  another  time  that  he 
sees,  or  hears,  or  walks  well.  The  following  case  illustrates  well 
the  intermittence  and  the  seemingly  hysterical  character  of  the 
symptoms.  A  young  lady  aged  sixteen,  whom  I  saw  two  or  three 
times,  complained  of  blindness,  imperfect  hearing,  and  loss  of 
power  in  the  legs.  Her  father,  a  clever  man  of  business,  was 
very  excitable,  and  had  had  more  than  one  attack  of  mania. 
An  aunt  was  peculiar,  and  her  sisters  were  nervous  and  hysteri- 
cal.    She  had  been  an  unusually  sharp,  cunning,  and  precocious 


234  PATHOLOGY  OF  MIND.  [cxIap. 

child,  always  very  nauglity,  destructive,  and  pleased  to  play 
miscliievous  and  malicious  tricks.  Slie  menstruated  at  the  aG:e 
of  eleven,  and  had  exhibited  erotic  tendencies  and  ideas,  not 
behaving  with  modesty  in  the  company  of  her  young  brother, 
and  showing  a  knowledge  of  sexual  matters  which  was  sur- 
prizing. She  was  expelled  from  school.  At  another  school 
to  which  she  was  sent  her  general  conduct  was  bad ;  she  was 
extremely  cunning  and  wilful,  and  at  various  times  had  hys- 
terical fits  of  laughing  and  crying.  One  day,  after  being  cor- 
rected for  bad  conduct,  she  declared  that  she  was  blind,  but  the 
schoolmistress  and  a  medical  m^in  who  saw  her  thought  she 
was  malingering.  In  a  few  days  she  recovered  her  sight.  After 
a  time  she  declared  again  that  she  was  blind  and  deaf  also, 
remaining  so  for  some  weeks,  when  her  hearing,  but  not  her 
sight,  returned.  All  the  medical  men  who  saw  her  thought  she 
was  badly  hysterical.  Later  on  the  deafness  returned,  and  she 
said  she  could  not  walk,  her  limbs  being  so  weak.  It  was  plain 
that  sometimes  she  could  both  see  and  hear.  Then  attacks  of 
excitement  occurred  from  time  to  time  in  which  she  shouted, 
laughed,  cried,  threw  herself  about,  struck  her  nurse ;  and  at 
last  total  blindness,  deafness,  and  paralysis  of  the  limbs  were 
indisputable.  She  complained  of  violent  headache,  became 
wildly  delirious,  and  died.  After  death  a  tumour,  supposed  to 
be  cancerous,  about  the  size  and  shape  of  a  hen's  egg,  was  found 
in  the  right  hemisphere. 

Another  example:  a  young  man,  ait.  twenty-four,  suffered 
from  frequent  and  severe  paroxysmal  pains  in  the  head, 
weakness  of  vision,  anxiety,  extreme  feeling  of  debility  and 
loss  of  power  in  the  limbs ;  there  was  also  confusion  of 
thought.  After  a  time  he  had  a  maniacal  attack ;  saw  balls 
of  fire  falling  about  him;  thonght  himself  pursued  by  mon- 
strous forms ;  was  very  violent.  The  excitement  lasted  for 
three  days  and  nights  without  sleep,  when  he  fell  into  a  deep 
sleep  which  lasted  for  twenty-four  hours,  awaking  from  it  quite 
conscious,  with  no  remembrance  of  his  previous  excitement. 
Again  headache  came  on,  with  noise  in  the  ears,  and  more  or 
less  paralysis  of  the  voluntary  muscles ;  the  maniacal  excite- 
ment recurred,  becoming  more  continuous,   and  the  paralysis 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      235 

and  mental  stupor  increased.  One  day  lie  could  neither  stand 
nor  move  his  arms  ;  but  after  a  tranquil  night  he  could  do  both 
quite  well,  and  could  return  intelligent  ans\Yers  to  questions. 
In  the  eveninf^  he  was  a^jjain  restless  and  excited ;  after  which 
he  became  comatose  and  died.  ISTumerous  cysts  of  cysticercus 
cellulosus  were  found  in  the  brain,  five  of  them  being  fixed  to 
the  inner  surface  of  the  dura  mater  and  the  rest  dispersed 
throughout  the  grey  matter.  By  far  the  greater  number  were 
found  in  the  grey  layers  of  the  hemispheres,  being  collected 
here  and  there  into  dense  groups.  In  another  case,  in  which 
twelve  cysticerci  were  found  after  death  in  the  brain,  the 
symptoms  were  those  of  gradually  increasing  dementia  with 
paralysis. 

It  is  well  known  that  a  person  may  lose  a  part  of  his  brain, 
and  yet  not  exhibit  any  mental  deficiency  or  disorder.  Indeed 
cases  have  been  recorded  which  go  to  show  that  one  hemisphere 
may  do  the  work  of  the  whole  brain ;  the  only  apparent 
consequence  of  the  destruction  of  the  other  hemisphere  being  a 
quicker  exhaustion  by  exercise  and  perhaps  a  greater  irrita- 
bility. This  being  so,  it  is  easy  to  understand  that  a  direct 
encroachment  upon  the  grey  layers  of  the  convolutions  by 
disease  may  take  place  without  causing  mental  derangement.^ 

!Much  has  been  written  lately  concerning  a  so-called  syphilitic 
insanity,  but  syphilitic  products  have  no  more  special  tendency 


*  The  following  case  is  reported  by  Dr.  A.  Scliwarzenthal  in  the  Wiener 
Medizinisclie  Presse  for  August  20,  1871  :  A  woman,  set.  BO,  a  day-labourer, 
who  had  previously  been  under  treatment  for  syphilis  and  leucorrhcea,  was 
admitted  to  the  hospital  in  Zolliiew,  suffering  with  headache,  Avhich  was  at 
that  time  of  several  weeks'  duration,  with  prostration  and  with  diminution 
of  appetite.  Febrile  exacerbations  occurred  sometimes  in  the  morning 
and  sometimes  in  the  afternoon,  and  it  was  consequently  thought  that  she 
had  intermittent  fever.  In  time  her  condition  had  so  much  improved  that 
she  was  discharged.  She  returned  to  lier  occupation,  doing  as  hard  work 
as  before  her  illness,  and  occasionally  frequenting  houses  of  iU  repute,  at 
one  of  which  she  died  suddenly  a  month  after  her  discharge  from  the 
hospital.  The  posterior  half  of  the  right  hemisphere  of  the  brain  was 
found  converted  into  a  large  abscess,  while  the  left  hemisphere  was  doughy 
to  the  feel,  and  the  cerebellum  was  softened.  From  the  history  of  the 
patient,  Dr.  S,  thought  that  the  abscess  of  the  brain  must  liave  existed  for 
three  months,  notwithstanding  that  during  all  that  time  there  had  been  no 
loss  of  consciousness,  and  that  during  part  of  it  she  had  been  able  to  do 
hard  work. 


23G  PATHOLOGY  OF  MIND.  [chap. 

to  produce  insanity,  than  any  other  tumour  or  gross  morbid 
product  in  the  brain.  Caries  of  the  skull  from  syphilis  may  do 
mischief  by  extension  of  morbid  action,  just  as  caries  from 
disease  of  the  bones  of  the  ear  may  do. 


CONCLUDING  REMARKS. 

A  pregnant  but  very  difficult  question,  of  which  little  or  no 
thought  has  ever  been  taken  by  writers  on  insanity,  is — What  is 
the  cause  of  the  particular  form  which  the  disorder  takes  in  a 
given  case  ?  Why  does  it  assume  one  complexion  rather  than 
another  ?  At  the  outset  it  is  certain  that  what  appears  to  be 
the  same  cause  shall  occasion  different  forms  of  insanity  in 
different  persons,  and  even  in  the  same  person  at  different 
periods  of  life,  and  that  the  same  form  of  disorder  shall  be  pro- 
duced by  different  causes  ;  this  being  so,  it  is  plain  that  the 
special  determining  conditions  lie  hidden  in  that  unknown 
region  which  w^e  call  by  such  names  as  temperament  and  idio- 
syncrasy. Unfortunately  these  big  words  are  at  present  little 
better  than  cloaks  of  ignorance ;  they  are  symbols  representing 
unknown  quantities  rather  than  words  denoting  detinite  con- 
ditions; and  no  more  useful  work  could  be  undertaken  in 
psychology  than  a  patient  and  systematic  study  of  individuals — 
the  scientific  and  accurate  dissection  and  classification  of  the 
minds  and  characters  of  particular  men  in  correlation  with 
their  features  and  habits  of  body.  How  vast  a  service  it 
would  indeed  be  to  have  set  forth  in  formal  exposition  the 
steps  of  the  quick  process  by  which  the  shrewd  and  experienced 
man  of  the  world  intuitively  judges  the  characters  of  those 
whom  he  has  to  do  with,  and  refers  them  in  a  moment  instinct- 
ively to  their  proper  classes'  in  his  mind !  Our  sj'stems  of 
ps^'chology  are  too  abstract  and  ideal  to  be  serviceable ;  disdain- 
ing to  concern  themselves  with  the  individual,  or  shirking  the 
tedious  work  of  observation  for  the  easier  work  of  speculation, 
they  give  no  help  whatever  in  the  education  of  the  sane  or  in 
the  treatment  of  the  insane  mind. 

Inasmuch  as  no  two  persons  in  the  world  are  exactly  alike  in 
their  mental  character  and  development,  no  two  cases  of  mental 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      237 

derangement  will  be  exactly  alike ;  the  varieties  of  their  morbid 
features  may  well  be  as  many  as  the  varieties  of  individual 
character.  The  brain  stands  not  on  the  same  footing  as  other 
organs  of  the  body  in  regard  to  its  development  as  the  special 
organ  of  mind ;  while  their  respective  development  and  function 
are  very  much  the  same  in  all  persons,  requiring  no  training  to 
do  their  work,  and  their  diseases  accordingly  are  closely  alike, 
the  real  evolution  of  the  brain  as  the  origan  of  mental  function 
takes  place  after  birth  in  relation  with  an  individual's  circum- 
stances, and  so  gives  rise  to  some  variety  of  function  in  each 
person  with  corresponding  variety  of  structure  in  the  delicate 
fabric  of  thought;  wherefore  it  is  that  each  of  two  cases  of 
deranged  mind  which  resemble  one  another  in  the  general 
features  of  exaltation  or  of  depression,  and  perhaps  also  in 
the  character  of  the  delusions,  will  still  display  its  particular 
features.  ISTotwithstanding  these  superficial  varieties  of  details, 
however,  there  is  great  sameness  in  the  leading  types  of  insanity, 
which  makes  it  in  the  end  monotonous  and  oppressive ;  the 
patients  fall  into  one  or  other  of  a  few  classes,  and  those  who 
consort  with  them  may  justly  complain  of  the  lack  of  invention  ; 
the  manifold  differences  are  superficial  and  incidental,  the  same- 
ness is  fundamental  and  essential ;  and  it  is  certain  that  he  who 
has  studied  well  the  inmates  of  one  large  asylum  will  know  the 
essential  character  and  main  features  of  the  madness  of  all  ages, 
of  all  countries,  and  of  all  classes  of  men.  Productive,  in  the 
sense  of  creative,  activity  is  the  highest  function  of  the  best 
endowed  and  most  soundly  developed  mind. 

As  a  general  thing  it  may  be  presumed  that  the  melancholic 
temperament  will  predispose  to  a  melancholy  madness,  the  san- 
guine temperament  to  a  more  expansive  variety  of  derangement, 
the  suspicious  temperament  to  a  derangement  in  which  delusions 
of  persecutions  prevail.  But  this  is  not  always  so :  a  melan- 
cholic person  may  rage,  and  a  sanguine  person  may  mope  in 
madness.  The  seat  of  the  primary  disease  sometimes  affects 
the  result ;  injury  to  the  head  and  gross  disease  of  the  brain 
tend  to  cause  intellectual  rather  than  emotional  disorder,  while 
abdominal  disease  favours  the  occurrence  of  emotional  depres- 
sion ;  the  organic  conditions  of  the  intellect  being,  as  Muller 


238  PATHOLOGY  OF  MIND.  [cuap. 

remarked,  mainly  in  the  brain  itself,  and  "  the  elements  which 
maintain  the  emotions  or  strivings  of  self,  in  all  parts  of  the 
organism."  However,  tliis  is  true  only  of  disease  of  brain  which 
has  made  some  progress,  since  the  derangement  caused  by  injury 
and  gross  disease  is  often  mainly  emotional  in  its  early  stages ; 
the  probable  reason  being  that  at  this  stage  the  initial  disturb- 
ance in  the  nerve-centres  is  very  much  the  same  as  that  which 
is  caused  by  irritation  from  a  distant  organ  or  by  vitiated  blood. 
It  has  not,  at  any  rate,  gone  beyond  the  stage  of  functional 
derangement,  which  has  emotional  expression,  into  the  farther 
stage  of  disorganisation  of  structure  which  implies  intellectual 
derangement.  When  disease  of  the  heart  goes  along  with  mental 
disorder,  not  seemingly  as  an  accident,  but  in  an  essential  con- 
nection with  it,  as  it  sometimes  does,  the  latter  usually  takes  the 
melancholic  form  with  extreme  apprehensions  and  fears — a  sort 
of  loanioliolia  ;  it  yields  indeed  a  striking  contrast  to  the  more 
or  less  active  mania  which  goes  along  with  tubercular  disease 
of  the  lungs  in  some  instances.  Notable  in  this  relation  is  the 
extremely  sanguine  disposition  of  the  phthisical  patient  who, 
not  being  in  the  least  insane  in  mind,  is  buoyant  with  unfailing 
hope  in  spite  of  fast-failing  strength,  and  perhaps  projects  on 
the  very  edge  of  his  grave  what  he  will  do  many  years  after  he 
shall  have  been  laid  in  it. 

The  bodily  changes  that  accompany  the  changes  of  age  have 
somethincy  to  do  with  the  form  which  the  disease  takes.    No  one 

O 

feels  and  thinks  concerning  the  things  of  this  world  at  fifty 
years  of  age  as  he  did  at  thirty ;  what  wonder  then  that  the 
character  of  the  mental  derangement  befalling  at  these  ages 
should  differ?  Breaking  out  in  youth  and  active  manhood,  when 
the  circulation  of  the  blood  is  vigorous  and  the  energies  of  the 
body  are  at  tlieir  full  height,  mania  will  be  more  common  than 
melancholia,  unless  the  health  has  been  brought  low  by  long- 
suffering  of  body  or  mind  previous  to  the  outbreak  ;  in  old  age, 
when  the  circulation  is  languid  and  the  vessels  a.re  undergoing 
degeneration,  and  v/hen  bodily  energy  is  waning,  ii?ome  variety  of 
melancholta  or  some  degree  of  decay  of  mind  is  more  often  met 
with.  Sex  again  will  obviously  impress  its  mark  upon  the 
mental  disorder  in  some  instances,  although  it  does  not  make  so 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       230 

niucli  dilTerence  in  the  main  types  thereof  as  one  nob  considering 
the  uniformity  of  passion  in  the  sexes  might  expect.  It  is  clear 
as  day  that  temporary  bodily  conditions,  hovever  they  may  have 
been  brought  about,  will  play  their  part ;  and  it  may  well  be  that 
future  researches  will  discover  the  causes  of  the  characteristic 
features  of  some  varieties  of  mental  derangement  in  the  diathetic 
states  and  the  actual  bodily  disorders  which  are  associated  with 
them.  Should  this  come  to  pass,  we  may  hope  to  be  put  in 
possession  of  more  exact  and  complete  medical  histories  than 
we  have  now,  upon  which  may  be  raised  in  due  time  a  natural 
classification  of  insanity  that  shall  furnish  definite  information 
concerning  the  cause,  course,  probable  termination  and  most 
suitable  treatment  of  a  particular  case  which  belongs  to  one  of 
its  classes. 

The  degree  of  development  which  the  mind  has  reached  cannot 
fail  to  imprint  some  marks  upon  the  phenomena  of  its  derange- 
ment ;  these  will  be  more  various  and  complex  in  proportion  as 
it  is  more  cultivated.  A  child  soon  after  its  birth  could  not 
manifest  true  ideational  disorder ;  it  must  acquire  ideas  before 
it  can  have  them  deranged.  For  the  same  reason  the  madness  of 
an  Australian  savage  will  be  a  simpler  matter  than  that  of  a 
normal  European,  which  may  be  expected  to  exhibit  evidence  of 
the  wreck  of  culture  and  perhaps  of  its  degree  also.  The  belief 
in  witchcraft  is  common  among  savages,  and  it  is  not  surprising 
therefore  that  a  melancholic  savage  oftentimes  has  the  delusion 
that  he  is  bewitched.  Had  an  insane  person  in  this  country 
that  delusion,  we  might  feel  sure  that  he  was  not  very  enlight- 
ened ;  if  he  had  more  knowledge  he  would  probably  ascribe  his 
sufferings  to  persecution  by  magnetism  or  by  some  mysterious 
chemical  agency.  The  delusions  of  the  insane  present  broken 
reflections  of  the  principal  beliefs  of  the  age,  and  of  the  social 
and  political  events  of  the  time  ;  so  much  so  that  Esquirol 
affirmed  he  could  trace  the  history  of  the  French  Eevolution 
from  the  taking  of  tlie  Bastile  down  to  the  last  appearance  of 
Buonaparte  in  the  character  of  the  insanity  which  occurred 
during  its  successive  ^jhases.  Any  striking  incident,  or  any 
great  personage  who  is  much  before  the  public  gaze,  is  apt  to  be 
laid  hold  of  by  the  insane  mind  and  to  be  made  the  occasion  of 


210  PATHOLOGY  OF  MIND.  [chap. 

a  delusion.  It  is  of  little  moment  then  in  most  cases  what  the 
particular  delusion  is  ;  the  important  thing  is  the  affective  mood 
in  which  it  is  rooted,  and  from  which  it  draws  its  life.  The 
vain  and  ambitious  person  may  claim  to  be  an  inspired  prophet 
or  even  Jesus  Christ,  if  his  thoughts  have  been  much  given  to 
religious  matters ;  to  be  a  king  or  a  prime  minister,  if  he  is  a 
politician ;  to  have  solved  the  problem  of  perpetual  motion,  if 
he  has  a  smattering  of  physics :  it  matters  not  what  he  thinks 
himself;  no  cure  will  be  found  for  his  delusion  of  greatness  so 
long  as  he  is  swollen  with  the  conceit  of  which  the  delusion  is 
the  morbid  outcome. 

Whosoever  surveys  madness  as  a  whole,  considering  within 
himself  that  there  must  be  at  bottom  somethincj  which  all  cases 
have  in  common,  and  asks- what  is  the  quality  of  nature  which 
shows  most  in  those  who  become  its  victims,  shall  have  occasion 
for  some  instructive  reflections.  One  thinor  fails  not  to  be 
brought  forcibly  home  to  those  w^ho  live  among  the  insane — 
namely,  how  completely  they  are  wrapped  up  in  self,  and  w^liat 
little  hold  the  cares  and  calamities  of  those  who  have  been 
living  intimately  with  them  ever  take  of  them.  It  would  be 
no  exaggeration  to  say  that  a  person  might  live  for  years  with  a 
company  of  insane  people  who  were  far  from  being  demented, 
and,  appearing  no  more  among  them  because  of  sickness  or  of 
death,  hardly  be  asked  for  more  than  once  out  of  a  transitory 
curiosity.  Living  together  for  years  they,  as  a  rule,  show  no 
interest  in,  and  no  sympathy  with,  one  another.  It  is  not  a 
conscious  selfishness  on  their  part ;  their  own  morbid  feelings 
and  morbid  thoughts  engross  their  attention  so  entirely  that 
nothing  that  affects  others  touches  them  deeply.  Another 
observation  wdiich  those  w^ho  have  to'  do  with  insane  persons 
have  frequent  occasion  to  make  is,  that  when  they  are  recovered 
they  seldom  evince  any  gratitude  for  what  has  been  done  for 
them,  however  much  attention  and  anxiety  their  sufferings  may 
have  claimed  and  received  ;  with  some  rare  exceptions  they  are 
quick  to  forget  services  and  hasten  to  ignore  any  sense  of  obli- 
gation. No  doubt  this  is  owing  partly  to  the  social  prejudice 
against  insanity;    it   is    natural    that    they   should    shun    all 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       241 

reference  to  a  calamity  which  their  relatives,  who  perhaps  share 
their  peculiarity  of  temperament,  are  nervous  unwilling  they 
should  refer  to,  and  which  the  world  looks  upon  as  something 
like  disgrace.  But  this  is  not  the  whole,  nor  always  the  main 
reason  :  some  of  them  cannot  sincerely  recognise  that  they  have 
been  as  ill  as  people  have  thought  them,  perhaps  in  their  hearts 
ascribe  their  insane  doings  to  the  treatment  which  they  under- 
went, and  w^hile  remembering  acutely  every  particular  of  what 
they  suffered,  forget  entirely  what  they  made  others  undergo. 
Nor  can  we  wonder  at  it  when  we  reflect  how  strong  is  the  ten- 
dency of  any  sane  person  whose  passions  are  stirred  or  whose 
interests  are  deeply  engaged  to  see  things  from  his  own  point  of 
view  exclusively,  and  to  transform  his  own  perturbed  feelings 
into  qualities  of  the  object,  and  how  complete  his  incapacity  is 
to  take  an  opponent's  standpoint  and  to  enter  into  his  feelings. 
It  has  been  said  that  anger  is  a  short  madness  ;  it  would  be  no 
less  true  to  say  that  madness  is  sometimes  a  long  passion. 

Having  noted  this  extreme  development  of  what  may  be 
called  selfhood  or  self-feeling  among  the  insane — for  it  is  not 
that  conscious  self-love  which  is  properly  selfishness — one  may 
fitly  inquire  whether  it  is  not  oftentimes  the  morbid  develop- 
ment of  a  natural  disposition.  It  will  be  found,  I  think,  that  a 
great  many  persons  who  have  gone  insane  have  had  intense 
self-feeling  without  a  counterbalancing  intellectual  grasp.  The 
friends  of  such  a  one  will  say  of  him  perhaps  that  he  was  of  a 
very  sensitive  nature,  that  he  could  not  bear  criticism  or  opposi- 
tion, that  they  found  it  necessary  often  to  keep  disagreeable 
things  from  him,  and  the  like ;  and  this  they  wdll  say  sometimes 
not  by  way  of  apology  for  an  infirmity,  but  as  if  ife  were  a 
virtue  of  a  finer  nature  than  common,  and  as  if  it  w^ere  not 
every  person's  business  in  the  world  to  have  and  to  bear  all 
sorts  of  impressions.  There  is  a  class  of  persons  wdio  are  unable 
to  bring  themselves  into  sober  and  healthy  relations  of  sincerity 
with  the  circumstances  of  life ;  who  let  feeling  loose  and  give 
rein  to  imagination  on  all  occasions ;  who  are  wanting  in  quiet 
reasonableness,  and  cannot  apprehend  the  notion,  much  less  do 
the  practice,  of  the  subordination  of  self  as  an  element  in  a  com- 
plex whole;  some  of  them  turn  all  impressions  to  suspicion. 


212  PATHOLOGY  OF  MIND.  [chap. 

take  offence  easily,  brood  over  slights,  magnify  trifles,  feel 
acutely  that  opposition  hurts  their  self-love,  and,  identifying  their 
selfhood  with  truth  and  right,  persuade  themselves  that  they 
are  suffering  great  wrong.  They  are  sometimes  very  insincere, 
though  not  always  consciously  so ;  assenting  eagerly,  effusively, 
and  for  the  time  being  sincerely,  to  some  proposal  or  advice, 
immediately  afterwards  the  liabitual  distrust  of  their  self- 
regarding  tendency  invites  its  sympathetic  ideas,  and  they  begin 
to  discover  hidden  motives  of  self-interest  in  the  adviser's  counsel, 
and  repent  of  their  assent.  Acute  in  their  suspicions,  they  in- 
variably overreach  themselves  and  fall  into  the  hands  of  plausible 
charlatans  who  play  upon  their  weaknesses.  That  is  one  reason 
why  ignorant  but  audacious  impostors  have  a  success  in  lunacy 
practice  which  they  could  not  have  if  real  medical  knowledge 
and  skill  were  required  of  them-. 

Others  who  are  not  entirely  wrapped  up  in  themselves  are 
almost  wholly  wrapped  up  in  their  families ;  it  is  a  sort  of 
vicarious  gratification  of  self.  One  hears  it  said  of  some  woman 
who  has  fallen  melancholic,  and  who  thereupon  displays  all  the 
self-indulgent  habits  so  common  in  such  cases,  that  she  was  a 
most  amiable  person,  singularly  devoted  to  her  husband  and 
children,  not  in  the  least  regardful  of  self,  and  that  she  is  now 
as  unlike  her  true  self  as  can  possibly  be  imagined.  But  hus- 
band and  children  do  not  really  constitute  the  world,  and  an 
excessive  devotion  to  them  might  in  such  case  be  the  most 
thorough  gratification  of  self,  and  too  exclusively  absorbing  to 
mark  a  wholesome  reasonableness  of  life.  So  again  a  person 
who  is  generous  in  giving  away  money  may  have  been  extremely 
self-regarding,  self-fostering,  perhaps  little  scrupulous  in  the 
getting  of  it ;  and  if  he  becomes  a  moaning  hypochondriac  or 
melancholic  who  can  do  nothing  but  think  and  talk  of  himself 
and  his  sufferings,  it  is  not  perhaps  quite  true  to  say  that  his 
present  self  is  not  in  the  least  like  his  former  self. 

It  is  a  common  but  by  no  means  indisputable  opinion  that 
the  philanthropist  is  the  least  selfish  of  men;  it  would  be  more 
true  to  say  that  he  is  commonly  a  person  of  extraordinary  self- 
feeling  who  finds  gratification  thereof  in  his  philanthropic 
labours.     Touched  acutely  in  his  feelings   by  the  spectacle  of 


v.]        Tllli  CAUSATION  AND  PREVENTION  OF  INSANITY.      243 

sufFeriug  and  of  wrong,  lie  reacts  with  an  intensity  of  immediate 
energy  in  the  endeavour  to  make  things  better,  and  he  obtains 
a  relief  of  his  lacerated  feelings  as  well  in  proclaiming  to  the 
world  how  nnich  he  is  afflicted  and  in  depicting  vividly  the 
wrongs  which  afflict  him,  as  in  active  works  of  benevolence. 
All  the  while  he  may  be  minutely  and  habitually  exacting  and 
self-indulgent  in  his  family  relations.  The  philanthropy  which 
embraces  mankind  is  indeed  too  apt  to  overlook  the  family ;  and 
there  are  not  wanting  examples  to  prove  that  the  martyrs  in  the 
cause  of  mankind  can  make  martyrs  of  those  who  are  in  daily 
intimate  relations  with  them.  The  humble  and  irksome  duties 
and  abnegations  of  daily  life  exact  quiet  and  steady  self-disci- 
pline, yield  no  striking  occasions  for  the  ease  of  outraged  senti- 
ment, claim  not  public  attention  and  sympathy,  necessitate  an 
unostentatious  subordination  of  self  and  its  affections.  They  do 
not  suit  well,  therefore,  with  the  sentiment-nursing  character  of 
the  philanthropist  and  with  the  vanity  which  the  public  pursuit 
of  his  ends  is  apt  to  foster.  The  world  does  well,  no  doubt,  to 
applaud  the  philanthropist  for  the  work  which  he  does,  in  order 
to  the  encouragement  of  men  to  set  before  themselves  high  aims 
of  human  welfare,  but  on  the  whole  it  is  well  for  the  world  that 
it  is  not  composed  entirely  of  philanthropists. 

The  religious  ascetic  of  former  times,  who  fled  from  the  society 
of  men  to  some  hole  in  the  rocks  or  to  some  desolate  place  of 
the  desert,  and  there  inflicted  upon  himself  all  the  sufferings 
which  his  invention  could  devise,  mortifying  his  body  with  long 
fastings  and  many  stripes,  was  persuaded  that  he  did  a  very 
holy  thing,  and  was  applauded  by  the  world  as  a  great  saint. 
The  truth  was  that  he  had  nursed  an  exaggerated  selfhood  into 
something  like  madness.  So  far  from  having  the  merits  which  he 
imagined  himself  to  have,  he  would  liave  found  it  a  much  harder 
penance  for  him,  as  well  as  a  more  wholesome  discipline,  to  have 
done  his  modest  work,  like  other  people,  as  a  humble  member  of 
society.  As  it  was,  by  bringing  his  body  into  a  state  of  emacia- 
tion, and  by  engaging  his  thereby  enfeebled  mind  in  continual 
meditations  on  what  Satan  would  do  specially  to  tempt  and  to 
torment  him,  or  God  would  do  miraculously  to  comfort  and  to 
sustain  him,  he  bred  hallucinations  which  he  believed  to  be  actual 


244  PATHOLOGY  OF  MIND.  [chap. 

apparitions  to  him  of  the  Holy  or  of  the  Evil  One.  If  he  did 
not  truly  see  visions  of  that  sort,  he  had  brought  himself  to  so 
unstable  aad  spasmodic  a  state  of  mind  as  to  declare  he  did 
without  being  sincerely  conscious  of  his  insincerity ;  not  other- 
wise than  as  hysterical  women,  morbidly  eager  to  gain  sympathy 
and  notoriety,  will  counterfeit  all  sorts  of  diseases,  or,  if  their 
minds  have  dwelt  much  on  sexual  matters,  will  accuse  innocent 
persons  of  criminal  assaults  upon  them,  without  being  themselves 
sincerely  conscious  of  their  duplicity  and  fraud.  Were  we  to 
believe  the  accounts  which  some  of  these  saints  gave  of  their 
encounters  with  the  devil,  we  should  be  driven  to  conclude  that 
he  had  put  aside  all  other  business  in  order  to  use  his  utmost 
and  undivided  energies  to  shake  their  steadfast  righteousness. 
Their  fanatical  follies  were  really  the  outcomes  of  insane  self- 
hood which  had  identified  itself  with  religion,  just  as  the  sancti- 
monious and  self-righteous  Pharisee  identifies  his  pride  with 
religion,  and  thanks  God  that  he  is  not  as  other  men  are.  But 
as  an  ape  seems  more  deformed  from  its  resemblance  to  man,  so 
the  aping  of  humility  by  religious  pride  makes  it  more  odious. 

We  perceive  then  that  a  character  v/hich  persons  who  become 
insane  often  have  in  common  is  an  exaggerated  and  ill-tempered 
self-feeling,  by  reason  of  which  they  are  unable  to  see  things  in 
their  true  relations  and  proportions  to  themselves  and  to  one 
another.  Great  self-feeling  with  little  self-knowledge  and  little 
self-control  is  the  soil  most  propitious  to  the  growth  of  egoistic 
passion :  either  to  such  passion  as  marks  the  striving  of  the  indivi- 
dual for  increased  gratification  of  self,  as,  for  example,  ambition, 
avarice,  love ;  or  to  such  passion  as  marks  the  reaction  of  self 
against  that  which  opposes  its  gratification,  as,  for  example, 
envy,  jealousy,  wounded  self-love,  despondency.  And  the  natural 
outcome  of  such  a  passion  grown  to  excess  is  delusion.  But 
there  is  countervailing  advantage  in  great  self-feeling — that  it 
imparts  great  earnestness  and  intensity  to  character :  what  is  an 
evil  sometim.es  in  supplying  strength  to  narrow  convictions  and 
fire  to  intemperate  zeal  is  a  benefit  to  the  individual  in  enabling 
him  to  make  a  stand  undaunted  against  opposition,  though  he 
stand  alone.  The  good  side  of  this  we  see  exemplified  in  the 
reformer ;  the  bad  side  of  it  in  the  lunatic.     A  conviction  gains 


v.]      THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      245 

infinitely  in  strength,  as  Novalis  remarked,  when  another  person 
believes  it,  as  another  person  will  not  fail  to  do  if  it  be  based 
upon  sound  experience  and  be  a  true  evolution  of  thought. 
But  the  lunatic's  conviction  needs  not  in  the  least  the  increase 
of  strength  which  sympathy  of  thought  gives  ;  assent  adds 
nothing  to  its  force,  nor  does  dissent  take  anything  from  it ;  he 
would  not  believe  more  firmly  in  it  if  all  the  world  believed 
with  him,  and  he  holds  fast  to  it  notwithstanding  that  all  the 
world  scorns  it.  One  might  say  then  of  great  self-feeling  that 
it  confers  the  power  of  becoming  a  reformer  or  the  liability  of 
becoming  a  lunatic  according  as  the  circumstances  of  life  are 
propitious  or  not,  and  according  to  the  greater  or  less  capacity 
of  intellectual  insight  and  of  self-control  by  which  it  is 
accompanied. 

It  was  Aristotle  who  took  notice  that  great  men  are  inclined 
to  be  melancholy  and  hypochondriac.  In  them  the  self-feeling 
is  great;  they  do  not  easily  subordinate  themselves  to  things  as 
they  are,  but  would  have  them  as  they  should  be  ;  accordingly, 
when  their  energies  are  directed  outwards  to  the  accomplishment 
of  some  aim  under  the  guidance  of  their  superior  insight,  the 
earnestness  of  great  feeling  inspires  their  convictions  and  is 
infused  into  their  actions;  such  happy  use  of  their  energies 
freeing  them  from  their  melancholy.  When  they  are  not  actively 
employed,  having  no  more  great  things  to  do,  they  are  prone  to 
fall  back  into  melancholy,  although  they  have  commonly,  by 
virtue  of  their  great  intellectual  power,  sufficient  self-control  to 
prevent  it  from  passing  into  actual  insanity. 

Weighing  well  the  manner  of  its  causation,  as  set  forth  in  the 
foregoing  pages,  it  is  obvious  that  mental  derangement  must 
needs  be  a  matter  of  degree.  There  may  be  every  variety  {a) 
of  deficient  original  capacity,  that  is  of  deficient  development 
of  the  substratum  of  the  mental  organisation,  whereby  the  indi- 
vidual is  born  inca23able  of  successful  adjustment  to  his  environ- 
ment, ancestral  antecedents  being  to  blame;  (h)  of  deficient 
development  of  the  mental  organisation  after  birth,  the  cause 
thereof  lying  in  some  injury  or  disease,  or  in  faulty  education — 
that  is,  in  unfavourable  conditions  of  the  environment ;  and  (c) 


246  PATHOLOGY  OF  MIND.  [r:v.^P. 

of  degree  of  degeneration,  attesting  the  divers  results  of  deranged 
interaction  between  the  individual  and  liis  environment.  Be- 
tween tlie  lowest  depths  of  idiocy  and  madness  and  the  highest 
reach  of  mental  soundness  there  are  numerous  varieties  shading: 
so  insensibly  into  one  another  that  observation  may  pass  along 
the  whole  series  by  a  gentle  gradient,  and  it  will  be  impossible 
for  any  one  to  draw  a  definite  line  to  mark  where  sanity  ends 
and  insanity  begins.  It  is  no  wonder  then  that  the  question  of 
civil  and  criminal  responsibility  in  these  cases  should  be  a  most 
difficult  one  to  answer :  on  the  one  hand,  there  are  insane 
persons  who  are  responsible  for  what  they  do,  inasmuch  as  they 
are  plainly  determinable  by  considerations  of  self-interest,  and  are 
capable  of  much  self-control  and  of  keen  foresight  when  they 
have  strong  enough  motives  to  exercise  them  ;  on  the  other  hand, 
some  sane  persons  are  plainly  not  responsible  for  what  they  do 
in  certain  circumstances,  since  no  motive  can  take  hold  of  them 
at  the  time  to  move  them  to  do  otherwise  than  as  they  do. 

There  are  two  views  of  insanity  prevalent  which,  in  order  to 
clearness  of  thought,  ought  to  be  distinguished — namely,  the 
medical  view  of  it  as  a  disease  requiring  treatment,  and  the 
legal  view  of  it  as  an  affliction  incapacitating  an  individual  from 
knowing  his  obligations  and  from  performing  his  functions  as  a 
citizen.  From  a  medical  point  of  view  a  person  may  be  so  insane 
as  to  justify  his  being  put  under  care  and  treatment  in  order  to 
be  cured — particularly  as  experience  has  proved  beyond  all 
question  that  the  sooner  suitable  treatment  is  used  the  b-etter  is 
the  chance  of  recovery,  and  the  longer  it  is  put  off  the  less  likely 
is  recovery  ever  to  take  place — who,  at  the  same  time,  may  not 
be  so  dangerous  to  himself  or  to  others  as  to  render  him  unfit  to 
be  at  large  and  to  have  the  care  of  his  own  property.  The  law 
admits  the  medical  view  of  the  necessity  of  treatment  by  sanc- 
tioning the  placing  of  a  person  of  unsound  mind  under  restraint 
as  "  a  proper  person  to  be  placed  under  care  and  treatment " ;  but 
it  goes  beyond  this  special  view  of  his  welfare  to  a  wider  con- 
sideration of  his  responsibilities  as  a  member  of  society :  it  does 
not  accept  unsoundness  of  mind  by  itself  as  a  discharge  from 
responsibility  for  criminal  acts  or  as  sufficient  evidence  of  in- 
capacity to  do  civil  acts,  but  exacts  proof  of  such  a  degree  or 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       247 

kind  of  insanity  in  a  particular  case  as  it  holds  to  be  sufficient 
to  abrogate  responsibility.  In  the  eye  of  the  law  then  a  man 
may  be  mad,  and  yet  not  mad  enough  to  be  irresponsible  as  a 
citizen — medically,  not  legally  mad;  he  may  be  a  proper  subject 
for  medical  treatment  because  of  derangement  of  mind,  and  at 
the  same  time  a  fit  stibject  for  judicial  condemnation  if  he 
breaks  the  law.  So  far  the  legal  doctrine  is  theoretically  just, 
although  its  practical  application  is  beset  with  difficulties. 

But  the  English  law  is  not  satisfied  to  rest  there  ;  it  goes  on 
to  set  up  authoritatively  an  artificial  criterion  of  responsibility 
in  criminal  cases,  and  insists  on  trying  every  case  by  it,  notwith- 
standing that  the  test  it  sets  up  is  unphilosophical  in  theory^ 
and  discredited  on  all  hands  by  practical  experience  of  insanity ; 
in  fact,  contrary  to  all  true  legal  principles,  it  goes  out  of  its 
way  gratuitously  to  lay  down  as  sound  law  an  exploded  psycho- 
logical doo-ma,  which  is  not  law  at  all,  but  false  doctrine — to  wit, 
that  the  insane  person  is  responsible  for  his  criminal  act  if  at 
the  time  of  doing  it  he  knew  he  was  doing  wrong,  or  knew  that 
the  act  was  contrary  to  law.  We  may  bring  home  to  our  minds 
in  the  clearest  way  the  meaning  and  the  working  of  this  test, 
when  strictly  applied,  by  considering  what  would  be  the  pro- 
bable working  of  an  enactment  that  every  person  suffering  from 
convulsions  of  any  sort,  whose  consciousness  was  not  entirely 
suspended  while  they  lasted,  should  be  held  strictly  responsible 
for  not  stopping  them.  As  no  one  who  knows  anything  of 
mental  philosophy  believes  impulses  to  action  to  come  from  the 
intellect,  and  to  be  always  under  its  sway,  and  as  no  one  who 
has  had  much  to  do  practically  with  insanity  has  the  least  doubt 
that  a  person  labouring  under  it  is  constrained  sometimes  by  his 
disease  to  do  what  he  knows  to  be  wrong,  having  perhaps  gone 
through  unspeakable  agony  in  his  efforts  to  withstand  the 
morbid  impulse  before  he  yielded  to  it  at  the  last,  all  suitable 
occasions  should  be  taken,  in  order  that  right  and  justice  may  in 
the  end  prevail,  to  declare  how  unjust  is  the  legal  maxim,  and 
to  protest  against  its  application. 

Another  but  less  serious  fault  in  the  law  concerning  lunacy  is 
the  want  of  proper  provision  for  the  discriminative  treatment  of 
those  who  have  been  pronounced  by  it  to  be  persons  of  unsound 


248  PATHOLOGY  OF  MIND.  [chap. 

mind ;  for  the  judgment  is  made  in  all  cases  to  carry  with  it  tlie 
conclusion,  not  always  well  founded,  that  they  are  both  inca- 
pable of  taking  care  of  themselves  and  of  managing  their  affairs. 
iSTevertheless,  an  insane  person  is  sometimes  competent  to  manage 
his  affairs  who  is  not  fit  to  be  entirely  at  large ;  and,  on  the 
other  hand,  there  are  some  who,  not  being  competent  to  manage 
their  affairs,  might  very  well  be  permitted  to  be  at  large  after 
fitting  legal  provision  had  been  made  for  the  proper  management, 
of  their  property.  We  are  getting  too  much  into  the  habit  of 
looking  upon  insanity  as  a  special  and  definite  thing,  which 
either  is  or  is  not,  and  which,  if  it  is,  puts  the  sufferer  at  once 
out  of  the  category  of  ordinary  men ;  unmindful  that  we  are 
dealing  not  with  a  constant  entity,  but  with  a  multitude  of 
insane  individuals  who  manifest  all  degrees  and  varieties  of  un- 
soundness. A  consequence  of  this  habit  is  an  undue  readiness 
to  pronounce  insane,  and  to  confine  in  asylums,  persons  who 
exhibit  deviations  from  the  usual  tracks  of  thought  and  conduct^ 
which  in  former  times  would  have  been  considered  harmless,  or 
in  some  instances  actually  received  as  inspirations.  Thus  the 
world  is  now  robbed  of  the  good  which  it  might  get  from  eccen- 
tric ideas  and  novel  impulses ;  for  assuredly  in  the  past  it  has 
been  greatly  indebted  to  those  who  have  broken  away  from  the 
automatic  grooves  of  thought  and  conduct,  even  when  their 
originality  has  perhaps  been  only  the  beginning  of  insanity. 

With  these  observations  I  conclude  what  I  have  to  say  con- 
cerning the  causation  of  insanity.  They  will  have  shown 
perhaps  the  necessity  of  taking  wider  views  of  the  origin  and 
nature  of  the  disease  than  has  been  done  hitherto.  They  may 
admonish  us  too  not  to  let  these  abortive  minds  pass  without 
taking  to  heart  the  lessons  which  they  are  fitted  to  teach. 
Examples  of  failure  of  adaptation  to  the  conditions  of  life,  they 
trace  in  suffering  the  downward  path  of  degeneracy,  and  indicate 
at  the  same  time  the  opposite  path  of  evolution  ;  thus  they  teach 
that,  not  wasting  strength  in  vain  regrets  over  calamities  that 
are  past  remedy,  men  should  apply  themselves  diligently  to 
get  understanding  of  the  laws  of  nature,  and  to  bring  their 
lives  into  faithful  harmony  with  them. 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       249 


APPENDIX. 

'  In  order  to  illustrate  more  fully  this  chapter  on  the  causation 
of  insanity,  1  appended  in  former  editions  the  short  notes  of  fifty 
cases,  all  of  which  were  under  my  care  at  one  time,  and  in  which  I 
laboured  to  satisfy  myself  of  the  conspiring  causes  of  the  mental 
disease.  I  might  adduce  a  great  many  more  cases,  but  do  not,  as 
those  which  follow  cover  pretty  well  the  field  of  causation,  and, 
being  quoted  without  any  selection,  are  sufficient  for  purposes  of 
illustration. 

1.  A  captain  in  the  army,  and  the  only  surviving  son  of  his 
mother,  who  was  a  widow.  She  suffered  very  much  from  scrofulous 
disease,  and  he  was  wasting  away  with  suspected  phthisis.  Mental 
state,  that  of  demented  melancholia,  with  manifold  delusions  of 
suspicion  as  to  pernicious  vapours  and  other  injurious  agencies  that 
were  employed  against  him.  He  was  the  last  of  his  family,  two 
brothers  having  died  very  much  as  he  seemed  likely  to  die.  His 
grandfather  began  life  as  a  common  porter,  ultimately  became 
partner  in  a  great  manufacturing  business,  and,  having  amassed 
enormous  wealth,  made  a  great  display  in  London  on  the  strength 
of  it.  His  high  hopes  of  founding  a  family  on  the  wealth  which  it 
was  the  sole  aim  of  his  life  to  acquire  thus  issued. 

2.  There  was  direct  hereditary  predispo.-ition,  and  the  tempera- 
ment was  notably  excitable  through  life.  There  was  no  evidence 
of  excesses  of  any  kind,  but  there  had  been  great  business  anxieties. 
The  mental  disease  was  general  paralysis. 

3.  An  amiable  gentleman,  on  the  death  of  his  wife,  formed  an 
immoral  connexion  with  a  woman  of  loose  character.  Continual 
sexual  excesses,  with  free  indulgence  in  wine  and  other  stimulants, 
ended  in  general  paralysis. 

4.  A  conceited  Cockney,  the  son  of  a  successful  London  tailor 
and  money-lender,  mean  in  look  as  in  mind,  strongly  imbued  with 

-^ihe  tradesman's  spirit,  and  with  offensive  Dissenting  zeal.  Hope- 
lessly addicted  to  self -abuse,  and  suffeiing  from  the  disagreeable 
form  of  mental  derangement  which  follows  that  vice  sometimes. 

5.  Two  ladies  of  middle  age,  unmarried,  and  cousins.  They  both 
suffered  from  extreme  moral  insanity,  both  revealing  in  their  con- 
duct the  tyranny  of  a  bad  organisation.     There  was  much  insanity 


250  PATHOLOGY  OF  MIND.  [chap. 

in  the  family,  in  one  case  the  father  being  actually  insane  ;  and  in 
both  cases  the  parents  being  whimsical,  capricious,  and  very  in- 
judicious as  parents.  A  bad  organisation  made  worse  by  bad 
training. 

6.  An  unmarried  lady,  aged  40,  addicted  to  the  wildest  and 
coarsest  excesses,  though  of  good  social  position  and  of  independent 
means;  justifying  in  every  respect  her  conduct,  though  it  more  than 
once  brought  her  to  gaol.  Family  history  not  known,  but  insane 
pi'edisposition  suspected  strongly,  as  there  was  plainly  not  the  least 
moral  element  in  her  mental  organisation.  No  aim  nor  occupation 
in  life,  but  extreme  egoistic  development  in  all  regards. 

7.  A  publican,  jet.  31,  had  done  little  for  some  time  but  stupefy 
himself  with  brandy  in  his  own  bar-parlour.  The  consequence  was 
furious  mania  and  extreme  incoherence  :  acute  mania  from  con- 
tinued intoxication,  not  delirium  tremens. — Recovery, 

8.  A  woman,  set.  47,  of  dark  complexion,  sallow  skin,  and  bilious 
temperament,  who  was  said  to  have  sui^ered  much  from  her  hus- 
band's unkindness  and  domestic  anxieties,  underwent  ''  the  change 
of  life,"  and  became  extremely  melancholic.  Nothing  more  was 
knoA\Ti  about  her. — Recovery. 

9.  Hereditary  predisposition  marked.  First  attack,  set.  38,  when 
unmarried.  Second  attack,  set.  58,  she  having  a  few  years  before 
married  an  old  gentleman  in  need  of  a  nurse.  She  was  given  to 
taking  stimulants,  fancied  herself  ill,  and  was  always  having  the 
doctor  to  talk  over  her  ailments  and  to  recommend  her  some  stimu- 
lant ;  in  fact,  hypochondriacal  melancholia  grew  gradually  by  indul- 
gence into  positive  insanity. — Recovery. 

10.  A  married  lady,  set.  31,  without  children,  and  having  great 
e elf  feeling.  She  went  on  one  occasion  to  a  Methodist  meeting, 
wh 're  she  was  much  excited  by  a  violent  sermon  ;  immediately 
afterwards  went  mad,  fancying  her  soul  to  be  lost,  and  making 
attempts  at  suicide. — Recovery. 

11.  A  young  lady,  set.  25,  who  had  undergone  some  anxieties  at 
home,  suffered  a  disappointment  of  her  affections.  Blank  depression 
and  vacuity,  having  all  the  look  of  acute  dementia. — Recovery. 

12.  A  married  woman,  set.  44,  of  dark  and  bilious  temperament, 
had  never  had  any  children.  At  the  "  change  of  life  "  profound 
melancholia  came  on. 

13.  A  gentleman,  aged  60,  of  fine  sensitive  temperament,  whoso 
mother  was  said  to  have  been  very  flighty  and  peculiar,  had  himself 


?.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       251 

been  noted  for  peculiarities  through  life.  He  bocame  profoundly 
melancholic,  thinking  himself  ruined,  and  was  intensely  suicidal. 
Refusal  of  food.  Everything  taken,  however,  was  vomited,  and 
diagnosis  of  orga.nic  abdominal  disease,  probably  malignant,  was 
made. — Death  from  exhaustion. 

14.  A  bookseller,  vdt.  41,  temperate,  of  considerable  intellectual 
capacity,  but  of  inordinate  conceit ;  advocated  a  general  division  of 
property  and  other  extreme  theories.  Ultimately  he  got  the  notion 
that  there  was  a  conspiracy  against  him  on  the  part  of  the  Govern- 
ment, and  tried  to  strangle  his  w^ife  as  a  party  to  it.  After  an 
illness  of  two  years  he  died  of  phthisis,  with  many  of  the  symptoms 
of  general  paralysis.  The  bodily  disease  seemed  to  have  conspired 
with  a  great  natural  egoism,  and  thus  to  have  made  the  mental 
derangement  one  of  its  earliest  symptoms. 

15.  A  married  man,  set.  50,  of  anxious  temperament.  Profound 
melancholia ;  refusal  of  food.  Second  attack.  Apart  from  the  pre- 
disposition established  by  a  former  attack,  the  cause  seemed  to  be 
great  self -feeling,  assuming  a  religious  garb,  or  at  any  rate  getting 
its  dischai-ge  in  religious  emotion.  Yery  fervent  always  in  devo- 
tion, but  intense  egoistic  feeling ;  entii-e  reference  of  everything  to 
self,  and  natural  incapacity  to  take  an  objective  view. — Recovery. 

16.  A  single  lady,  set.  38,  fancied  herself  under  mesmeric  in- 
fluence, in  a  state  of  clairvoyance,  and  had  a  variety  of  anomalous 
sensations  about  her  body.  Rubbed  her  skin  till  it  was  sore  in 
places,  bit  her  nails  to  the  quick,  scratched  her  face,  &c.  Quasi- 
hysterical  maniacal  exacerbations,  in  which  she  could  not  contain 
herself,  but  tossed  on  a  couch  or  even  rolled  on  the  floor  in  violent 
unrest.  Irregularity  of  menstruation,  and  suspected  self-abuse. — 
Recovery. 

17.  A  lady,  set.  45,  but  looking  very  much  older,  having  had  an 
anxious  life.  Hereditary  predisposition ;  change  of  life ;  melan- 
cholic depression,  passing  into  destructive  dementia.  Convulsions, 
paralysis,  death.  Here  softening  of  the  brain  was  preceded  for 
some  weeks  by  mental  symptoms. 

18.  Hereditary  predisposition.  Great  excesses.  General  paralysis. 

19.  Habitual  alcoholic  excesses;  pecuniary  difficulties;  mania. 
After  some  years  hemiplegia  of  right  side,  muscular  power  being 
partially  regained  after  a  time.  The  patient  lived  for  years  thus. 
Paralysis  of  long  duration  was  the  usual  family  disease  and  cause 
of  death. 


252  PATPIOLOGY  OF  MIND.  [(.iiap. 

20.  Suicidal  insanity  in  a  married  lady.  Strong  hereditary  pre- 
disposition to  insanity.  Exhaustion  produced  by  lactation,  and 
mental  depression  occasioned  by  the  long  absences  of  her  husband 
from  home. — Eecovery. 

21.  Third  or  fourth  attack  of  acute  moaning  melancholia  in  a 
woman,  aged  40.  Intense  self-conceit  and  selfishness  natural  to 
her.  Gastric  derangement,  and  obstinately  constipated  bowels. 
Whenever  bodily  derangement  reaches  a  certain  pitch,  or  adversity 
occurs,  it  seems  to  upset  the  equilibrium  of  an  ill -balanced  mind, 
predisposed  to  disorder  by  an  exaggerated  egoism  and  by  former 
attacks. — Kecovery. 

22.  Gambling,  betting,  drinking,  and  sexual  excess.  General 
paralysis. 

23.  A  bad  organisation  plainly — not  due  to  actual  insanity  in 
family,  but  to  the  absence  of  moral  element.  A  life  of  great  ex- 
citement, and  of  much  speculation  in  Australia.  Alcoholic  and 
sexual  excesses  (?).     General  paralysis. 

24.  A  widow,  set.  58,  the  daugher  of  one  who  had  begun  life  as  a 
labourer  at  a  coal  wharf,  but  who  had  risen  to  be  an  employer,  and 
had  made  a  great  deal  of  money.  He  was  without  education,  so 
that  his  daughter,  brought  up  as  a  rich  person,  but  without  cultiva- 
tion of  body  or  mind,  did  not  get  opportunely  married  :  '*  She  was 
too  high  for  the  stirrup,  and  not  high  enough  for  the  saddle." 
When  50  years  old,  she  married  an  old  gentleman,  whose  former 
manner  of  life  had  made  a  nurse  needful  to  him.  He  died,  and  left 
her  the  income  of  a  large  property  for  her  life.  She  now  got 
suspicious  of  his  relatives,  to  whom  the  property  was  to  revert  on 
her  death  ;  was  harassed  with  her  money,  which  she  did  not  know 
what  to  do  with,  but  fancied  others  had  designs  on  ;  and  finally 
went  from  bad  to  worse  until,  believing  all  the  world  was  con- 
spiring against  her,  she  got  a  revolver,  and  threatened  to  shoot  her 
fancied  enemies. 

25.  The  daughter  of  a  common  labourer,  who  had  become  very 
rich  in  the  colliery  business,  set.  32,  single.  At  her  father's  death 
she  inherited  wealth  ;  was  without  any  real  education,  very  vulgar, 
and  spent  the  greater  part  of  her  time  in  drinking  gin  and  reading 
sensational  novels.  Great  hereditary  predisposition,  not  to  insanity 
only,  but  to  suicidal  insanity.  Suicidal  melancholia,  with  an  in- 
coherence approaching  dementia. 

26.  A  gentleman,  set.  34.     Steady,  quiet  drinking,  on  all  possible 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.       253 

occasions.  The  ''ne'er-do-weel"  of  the  family,  having  tumbled 
about  the  world  in  Mexican  wars  and  South  American  mines,  and 
in  other  places,  as  such  persons  do.  General  feebleness  of  mind  and 
specially  marked  loss  of  memory.  An  uncle  had  been  very  much 
the  same  sort  of  person,  and  had  died  in  an  asylum.  In  speakin"' 
of  himself — if  describing  what  he  had  been  doing,  for  example  — 
always  spoke  of  himself  as  ''you,"  as  though  he  were  addressing 
himself   as  some  one  else. 

27.  A  married  woman,  aged  49,  gaunt,  and  seemingly  of  bilious 
temperament.  After  a  fever  of  five  weeks'  duration,  called  "  gastr.'c," 
probably  typhoid,  acute  maniacal  excitement,  violence,  incoherence, 
Sic. — Recovery  within  a  fortnight. 

28.  Dementia  after  epilepsy,  the  fits  occurring  at  the  catamenial 
period.  Brother  maniacal,  and  sister  without  the  moral  element  ia 
her  disposition. 

29.  The  young  lady  before  mentioned  as  No.  11  was  removed  by 
a  penurious  father  from  medical  care  before  recovery  was  thoroughly 
established,  and  in  opposition  to  advice.  The  return  to  home 
anxieties  brought  on  an  attack  of  acute  mania,  with  endless  gabbling 
of  incoherent  rhymes. — Permanent  recovery  this  time. 

30.  A  warehouseman,  aged  35,  a  Primitive  Methodist,  much 
addicted  to  preaching.  He  had  accomplished  some  self-education, 
but  had  a  boundless  conceit,  and  infinite  self-feeling.  Indigestion, 
pyrosis,  frequent  vomiting  after  meals.  Melancholia,  with  delusion 
that  he  had  committed  the  unpardonable  sin  and  endless  moaning. 
Very  remarkable  was  the  evidence  of  self -feeling  in  his  case — self- 
renunciation  not  being  a  word  that  entered  into  his  vocabulary. 
This  man,  for  example,  though  well  aware  that  vomiting  followed 
eating,  and  sufficiently  aftlicted  thereby,  could  not  be  induced  to 
regulate  his  diet  voluntarily,  but  ate  gluttonously  unless  prevented. 

31.  A  married  woman,  set.  32,  of  stout  habit  of  body,  and  with 
habitually  locked  secretions.  The  sudden  death  of  a  son  brought 
on  severe  moaning  melancholia. 

32.  A  single  lady,  aged  57,  who  had  been  insane  for  thirty  years. 
There  was  the  strongest  hereditary  taint. 

33.  A  young  man,  extremely  delicate,  aged  22,  had  acute  de- 
mentia, following  acute  rheumatism.  There  was  valvular  disease 
of  the  heart,  with  loud  mitral  regurgitant  murmur. — Issue  of  the 
case  unknown. 

34.  A  tradesman's   daughter,   set.   24,   brought    up   in    idleness, 


254  PATHOLOGY  OF  MIND.  [chap. 

and  in  habits  unsuited  to  her  station.  Slight  hereditary  predis- 
position, much  aggravated  by  her  injudicious  education.  Domestic 
troubles  and  anxieties  after  marriage,  she  being  unequal  to  the 
management  of  a  household.     Mania. — Ptecovery. 

35.  A  woman,  vet.  30,  Wesleyan,  single.  Suicidal  melancholia 
with  the  delusion  that  her  soul  is  lost.  Menstrual  irregularity. 
Extreme  devotional  excitement,  with  evidently  active  sexual  feelings. 
— Recovery. 

36.  A  young  woman,  set.  25,  single,  AYesleyan.  Mania.  Cause, 
same  probably  as  in  the  last  case. — Recovery. 

37.  A  respectable,  temperate,  and  industrious  tradesman,  jet.  40, 
Wesleyan,  a  teetotaller,  and  much  superior  to  a  vulgar  wife.  Second 
attack.  His  father  committed  suicide  ;  his  brother  was  very  flighty. 
General  paralysis. 

38.  A  sober,  hardworking,  respectable  bookseller,  not  given  to 
excesses  of  any  kind,  so  far  as  was  ascertained.  But  here,  as  in 
many  other  cases,  one  lacked  knowledge  with  respect  to  possible 
marital  excesses.   Slight  hereditary  predisposition.   General  paralys's. 

In  both  these  last  cases  there  was  general  paralysis  in  men  who 
had  not  been  intemperate.  In  both,  however,  there  were  large 
families  of  children,  and  the  struggle  of  life  had  plainly  been  very 
anxious  and  severe. 

39.  A  woman,  set.  32.  Acute  mania  came  on  two  months  after 
childbirth. 

40.  A  lady,  set.  34,  single,  without  other  occupation  or  interebt 
than  religious  exercises.  Suicidal  melancholia,  with  the  delusion 
that  she  had  sold  herself  to  the  devil.     Amenorrhoea. — Recovery. 

41.  A  married  woman,  set.  40.  Sudden  outbreak  of  mania,  after 
going  to  a  revival  meeting.     Amenorrhoea. — Recovery. 

42.  A  married  man  with  a  family,  set.  52,  a  Dissenter,  holding 
an  office  of  authority  in  his  church,  and  most  exact  in  his  religious 
duties.  Secretly,  he  had  of  late  kept  a  mistress,  however,  and 
lived  a  rather  dissipated  life.  Outbreak  of  acute  mania,  with 
a  threatening  of  general  paralysis. — Recovery ;  for  a  time  at  any 
rate. 

43.  Acute  mental  annihilation  in  a  young  man  about  a  year  and 
a  half  after  marriage.  One  or  two  intervals  of  a  few  hours  of 
mental  restorat'on. — Death  in  epileptiform  convulsions.  Softening 
of  the  brain  in  extreme  degree,  but  limited  in  extent.  Excessive 
sexual  indulgence. 


v.]        THE  CAUSATION  AND  PREVENTION  OF  INSANITY.      255 

44.  A  married  woman,  ret.  44,  who  has  had  several  children,  and 
who  has  become  insane  after  each  confinement.  Extreme  maniacal 
incoherence  and  excitement,  with  unconsciousness  that  she  has  had 
a  child. — Eecovery. 

45.  Hereditary  predisposition.  A  Dissenter  of  extreme  views, 
narrow-minded  and  bigoted.  He  was  married  when  thirty-six 
years  old,  and  became  melancholic  a  short  time  after  the  birth  of 
his  first  child. — Recovery. 

46.  Complete  loss  of  memory  and  of  all  energy  of  character,  and 
failure  of  intelligence,  in  a  man,  set.  36,  single,  from  continual 
intemperance  in  drinking  and  smoking.  Has  previously  had  two 
attacks  of  delirium  tremens. 

47.  An  extremely  good-looking  young  widow,  who  had  been  a 
s'nger  at  some  public  singing-rooms  and  the  mistress  of  the  pro- 
prietor of  them.     Sexual  excesses.     General  paralysis. 

48.  Attack  of  acute  violent  mania  in  a  young  surgeon,  ast.  27. 
Afterwards  three  days  of  heavy  stertorous  sleep ;  then  seeming 
repovery  for  twenty-four  hours ;  but  on  the  next  day  recurrence 
of  mania,  followed  soon  by  severe  epileptic  fits. — Kecovery. 

49.  Extreme  moral  perversion,  with  the  most  extravagant  conceit 
of  self  and  unruly  conduct  in  a  young  man,  a  clerk.  Alternations 
of  deep  depres.sion  and  suicidal  tendency.     Cause,  self -abuse. 

50.  A  single  lady,  aged  41,  who,  on  her  return  from  school  when 
fifteen  years  old,  was  queer,  listless,  and  from  that  time  had  been 
rather  peculiar.  Hereditary  predisposition.  Acute  melancholia, 
with  the  delusion  that  she  is  lost  because  she  has  refused  an  offer 
of  marriage  from  a  clergyman,  such  offer  never  having  been  thought 
of  by  him. 


12 


CHAPTER  VI. 

THE  INSANITY  OF  EARLY   LIFE. 

How  unnatural !  is  an  exclamation  of  pained  surprise  which 
some  of  the  more  striking  instances  of  insanity  in  young 
children  are  apt  to  provoke.  However,  to  call  a  thing  unnatural 
is  not  to  take  it  out  of  the  domain  of  natural  law,  notwithstand- 
ing that  when  it  has  been  so  designated  it  is  sometimes  thought 
that  no  more  need  be  said.  Anomalies,  when  rightly  studied, 
yield  rare  instruction ;  they  witness  and  attract  attention  to  the 
operation  of  hidden  laws  or  of  known  laws  under  new  and 
unknown  conditions  ;  and  so  set  the  inquirer  on  new  and  fruit- 
ful paths  of  research.  For  this  reason  it  will  not  be  amiss  to 
occupy  a  separate  chapter  with  a  consideration  of  the  abnormal 
phenomena  of  mental  derangement  in  children. 

The  first  movements  of  the  child  are  reflex ;  but  sensorial 
perceptions  with  motor  reactions  thereto  follow  tl>ese  early 
movements  so  soon  that  we  can  make  only  an  ideal  boundary 
between  reflex  and  sensori-motor  acts.  The  aimless  thrusting 
out  of  a  limb  brings  it  in  contact  with  some  external  object, 
whereupon  it  is  probable  that  a  sensation  is  excited.  The  particu- 
lar muscular  exertion  must  also  be  the  condition  of  a  muscular 
feeling  of  the  act ;  so  that  the  muscular  sense  of  the  movement 
and  the  sensation  of  the  external  object  are  associated,  and  for 
the  future  unavoidably  suggest  one  another :  a  motor  intuition 
of  external  nature  is  thus  organised,  and  one  of  the  first  steps 
in  the  process  of  mental  formation  accomplished.  The  same 
educational  process  goes  on  in  the  exercise  of  the  movements  of 


CHAP.  VI.]  THE  INSANITY  OF  EARLY  LIFE.  267 

the  lips  and  tongue,  wbicli  are  the  parts  first  exercised  by  a 
child,  and  in  the  motion  of  its  hand,  which  it  puts  to  its  mouth 
in  order  to  suck  it.  Afterwards,  whatever  is  grasped  in  the 
hand  is  similarly  carried  to  the  mouth.  Thus  the  sensibility 
and  motion  of  the  lips  are  the  first  inlets  of  knowledge ;  the 
child  having  got  thereby  some  perception  of  an  external  object 
as  the  occasion  or  accompaniment  of  a  certain  association  of  sen- 
sations and  movements,  immediately  brings  any  object  which 
it  grasps  with  its  fingers  into  relation  with  these  means  c/f 
instruction.  In  this  way  the  hand  is  used  to  exercise  the  sen- 
sibility and  motions  of  the  lips,  and  the  knowledge  previously 
gained  through  them  is  applied  to  instruct  the  hand,  wliich  at 
a  later  period,  when  it  has  been  taught  by  its  own  experience,  is 
applied  to  other  parts  of  the  body,  in  order  to  help  to  interpret 
and  localise  their  sensations.  But  it  is  long  before  the  infant  can 
localise  a  sensation  in  another  part  of  its  body  than  its  lips  and 
hand ;  when  a  pin  in  its  dress  is  pricking  it,  for  example,  it  can 
only  cry  out  helplessly  ;  it  cannot  make  a  definite  effort  with 
the  hand  to  remove  it,  as  it  will  do  later  on,  when  it  has  learnt 
to  know  the  geography  of  its  own  body.  If  we  call  to  mind 
how,  when  discussing  actuation,  it  was  shown,  in  the  case  of  the 
eye,  that  a  sensation  was  the  direct  cause  of  a  certain  accommo- 
dating movement,  and  that  the  definite  movement  thereupon 
imparted  the  intuition  of  distance,  we  shall  perceive  how  the 
organic  association  of  a  sensation  from  without  with  an  associ- 
ated muscular  act  builds  up  by  degrees  definite  intuitions  of 
external  objects  in  the  young  mind. 

Suppose  now  that  an  infant  becomes  insane  soon  after  birth, 
what  sort  of  insanity  must  it  exhibit  ?  The  range  and  variety 
of  mental  disorder  possible  are  clearly  limited  by  the  extent  of 
existence  of  mental  faculty ;  which  is  almost  nothing.  In  this 
regard  the  observed  facts  agree  with  theory ;  for  when  a  child 
is,  by  reason  of  a  bad  descent  or  of  baneful  influences  during 
uterine  life,  born  with  such  an  extreme  degree  of  instabilitv  of 
nerve  element  that,  on  the  first  play  of  external  circumstances 
its  nervous  centres  react  in  convulsive  fashion,  it  mostly  dies 
in  convulsions.  The  disordered  action  proceeds  from  the  ner- 
vous centres  of  reflex  action — those  w^hich  alone  at  this  time 


258  PATHOLOGY  OF  MIND.  [chap. 

have  power  of  function  ;  the  convulsions  are  the  equivalent  in 
them  of  the  delirium  which  is  the  exponent  of  derangement 
of  the  ideational  centres, — might  be  said  to  represent  their 
insanity,  as  insanity,  on  the  other  hand,  represents,  so  to  speak, 
convulsive  action  of  the  higher  nervous  centres. 

In  consequence  of  the  close  connection  of  sensorial  action 
with  reflex  action  in  the  infant — the  actual  continuity  of 
development  which  exists — there  is  commonly  evidence  of 
some  sensori-motor  disturbance  in  the  earliest  nerve-troubles. 
An  impression  on  the  sense  of  sight,  for  example,  is  not  quietly 
assimilated  so  as  to  persist  as  an  organised  residuum  in  the 
proper  nervous  centre,  but  immediately  stimulates  the  un- 
stable cells  of  the  associate  motor  centres  to  irregular  and 
violent  actions,  which  may  be  of  a  more  or  less  purposive 
character ;  and  the  consequence  is  that  the  phenomena  of  a 
true  sensorial  insanity  are  intermixed  with  the  morbid  manifes- 
tations of  the  lower  nervous  centres.  Instances  of  such  morbid 
action  so  soon  after  birth  are  certainly  rare  ;  nevertheless  they 
are  met  with  now  and  then,  and  have  been  recorded.  Crichton 
quotes  from  Greding  a  well-known  case  of  a  child  which,  as 
he  says,  w^as  raving  mad  as  soon,  as  it  w^as  born.  "  A  woman, 
about  forty  years  old,  of  a  full  and  plethoric  habit  of  body, 
who  constantly  laughed  and  did  the  strangest  things,  but  who, 
independently  of  these  circumstances,  enjoyed  the  very  best 
health,  was,  on  the  20th  January,  1763,  brought  to  bed,  without 
any  assistance,  of  a  male  child  who  was  raving  mad.  When  he 
was  brought  to  our  workhouse,  which  was  on  the  24th,  he  pos- 
sessed so  much  strength  in  his  legs  and  arms  that  four  women 
could  at  times  with  difficulty  restrain  him.  These  paroxysms 
either  ended  in  an  uncontrollable  fit  of  laughter,  for  wdiich  no 
evident  reason  could  be  observed,  or  else  he  tore  in  anger  every- 
thing near  him, — clothes,  linen,  bed -furniture,  and  even  thread, 
when  he  could  get  hold  of  it.  We  durst  not  allow  him  to  be 
alone,  otherwise  he  w^ould  get  on  the  benches  and  tables,  and 
even  attempt  to  climb  up  the  walls.  Afterwards,  however, 
when  he  began  to  have  teeth,  he  died." 

If  there  be  not  exaggeration  in  this  description  it  must  be 
allowed  to  be  very  surprising  that  a  child  so  young  should  have 


VI.]  THE  INSANITY  OF  EARLY  LIFE.  259 

been  able  to  do  so  mucb ;  and  those  wlio  advocate  innate  mental 
faculties  might  well  ask  how  it  is  possible  on  any  other  sup- 
position to  account  for  so  extraordinary  an  exhibition  of  more 
or  less  co-ordinate  power  by  so  young  a  creature.  Two  con- 
siderations may  be  suggested  by  w^ay  of  lessening  the  extra- 
ordinary character  of  the  phenomena :  first,  that  the  mother  of 
the  child  was  herself  peculiar,  so  that  her  infant  inherited  an 
unstable  nervous  organisation,  and  consequently  a  disposition  to 
irregular  and  premature  reaction  on  the  occasion  of  an  external 
stimulus ;  and  secondly,  that  there  are  innate  in  the  constitution 
of  the  human  nerv^ous  system  the  aptitudes  to  certain  co-ordinate 
automatic  acts,  such  as  correspond  in  man  to  the  instinctive  acts 
of  animals.  Many  young  animals  are  born  with  the  power  of  using 
their  muscles  together  in  complex  ways  for  definite  ends  directly 
they  are  exposed  to  suitable  stimuli,  and  the  human  infant  is 
not  destitute  of  the  germ  of  a  like  power  over  voluntary 
muscles,  while  it  has  the  complete  power  of  certain  co-ordinate 
automatic  acts  ;  one  can  conceive,  therefore,  that,  without  will, 
and  even  without  consciousness,  it  may  display,  when  insane,  in 
answer  to  sensations,  actions  which  have  more  or  less  semblance 
of  design  inthem^ — in  other  words,  convulsions  that  are  more  or 
less  co-ordinate.  If  people  would  keep  open  minds  and  not  begin 
to  observe  with  a  pre-exist ent  idea  that  the  function  of  the 
highest  nerve-centres  means  something  essentially  different  from 
the  functions  of  lower  nerve-centres,  they  would  not  have  the 
difficulty  they  have  in  recognising  co-ordinate  convulsion.  We 
have  in  fact  convulsive  display  of  innate  co-ordinate  faculty  in 
irregular,  violent,  and  destructive  movements,  and  in  precocious 
acts  which  would  be  natural  in  a  more  restrained  form  at  a  later 
stage  of  normal  development,  such,  for  example,  as  "uncon- 
trollable fits  of  laughter  without  any  evident  reason."  ^  Without 

^  "  That  they  do  this  by  instinct,  something  implanted  in  the  frame,  the 
mechanism  of  the  body,  before  any  marks  of  wit  or  reason,  are  to  be  seen 
in  them,  I  am  fully  persuaded  ;  as  I  am  likewise  that  nature  teaches  them 
the  manner  of  fighting  peculiar  to  their  species  ;  and  children  strike  with 
their  arms  as  naturally  as  horses  kick,  dogs  bite,  and  bulls  push  with  their 
horns." — Mandeville's  Fahle  of  the  Bees,  vol.  ii.  p.  352. 

2  "  The  youngest  person  whom  I  have  seen  labouring  under  mania,"  says 
Sir  A.  Morison,  "  was  a  little  girl  of  six  years  old,  under  my  care  in 
Bethlehem  Hospital.     I  have,  however,  frequently  met  with  violent  and 


260  PATHOLOGY  OF  MIND.  [chap. 

doubt  the  paroxysms  of  violent  laughter  were  provoked  by  the 
morbid  condition  of  the  motor  centres,  not  by  any  mental 
conceit  of  the  infant. 

As  the  earliest  stages  of  the  infant's  mental  development  cor- 
respond in  a  general  way  with  the  permanent  condition  of  mind 
of  those  animals  whose  actions  are  reflex  and  sensori-motor,  it 
is  no  wonder  that  their  morbid  phenomena  are  comparable. 
Being  in  both  cases  mainly  referable  to  disorder  of  the  sensorial 
and  associate  motor  nervous  centres,  the  insanity  might  not 
unfitly  be  described  as  sensorial.  The  impressions  made  upon 
animals,  and  the  sensations  or  at  most  the  few  simple  and  im- 
perfect ideas  that  follow  them,  are  transformed  immediately 
into  movements,  as  they  are  also  in  children ;  nothing  like 
true  reflection  is  possible,  except  it  be  in  a  few  of  the  higher 
animals ;  consequently  when  the  impressions  are  morbid  they 
are  answered  instantly  by  morbid  movements.  The  elej^hant, 
usually  a  gentle  enough  creature,  is  subject  at  certain  seasons  to 
attacks  of  furious  madness,  in  which  it  rushes  about  in  the 
most  dangerous  way,  roaring  loudly  and  destroying  everything 
within  its  reach ;  and  other  animals  are  now  and  then  affected 
w4th  similar  paroxysms  of  what  might  be  compared  with  an 
epileptic  fury.  There  is  far  more  power  in  the  insane  elephant 
than  in  the  insane  infant,  and  it  is  able  to  do  a  great  deal  more 
mischief,  but  there  is  no  difference  in  the  fundamental  nature 
of   the  madness;  the  furious  acts  are  the  reactions  of  morbid 

immanageable  idiots  of  a  very  tender  age."  Dr.  Joseph  Frank  records 
having  seen,  on  a  visit  to  St.  Luke's  Hospital,  in  1802,  a  case  of  mania 
occurring  at  the  age  of  two  years. — Lectures  on  Insanity,  by  Sir  A.  Mori- 
son,  M.D.  In  the  Appendix  to  one  of  tlie  Reports  of  the  Scotch  Lunacy 
Commissioners,  mention  is  made  of  a  girl  aged  six  years,  who  was  said  to 
be  afflicted  with  congenital  mania.  She  was  illegitimate,  and  her  mother 
was  a  prostitute.  She  could  not  walk,  paraplegia  having  come  on  when 
she  was  a  year  old  ;  she  was  incoherent,  and  subject  to  paroxysms  of 
violent  passion  ;  at  all  times  very  intractable  ;  slept  little  and  ate  largely. 
All  such  cases  may  be  viewed  as  partial  idiots  from  birth.  The  cerebral 
organisation  at  so  early  an  age  is  so  delicate  that  it  does  not  bear  severe 
morbid  affections  without  losing  its  fitness  for  mental  development  and 
endangering  life.  Indeed  it  might  fairly  be  said  of  the  cases  of  insanity 
in  very  young  children,  that  some  are  examples  of  intellectual  deficiency, 
the  rest  examples  of  moral  perversion  or  deficiency,  with  or  without  excite- 
ment. Epilepsy  goes  along  with  the  mania  sometimes,  and  the  tendency 
is  to  burn,  tear,  injure,  destroy,  &c. 


VI.]  THE  INSANITY  OF  EARLY  LIFE.  261 

motor  centres  to  impressions  made  on  morbid  sensory  centres ; 
and  the  whole  mind,  whether  of  the  infant  or  of  the  animal,  is 
engulfed  in  the  convulsive  reaction.  Dogs  being  as  a  rule 
very  intelligent  animals,  because  of  their  intimate  association 
with  men  through  countless  ages,  exhibit  something  more  than 
sensorial  disorder  when  they  go  mad,  although  a  great  part  of 
the  phenomena  are  sensorial.  Their  disposition  and  habits 
notably  suffer  a  great  change ;  they  become  sullen,  dull,  irri- 
table, solitary  in  their  habits;  afterwards  hallucinations  evidently 
occur,  and  they  bite  alike  friends  who  are  kind  to  them  and 
strangers  who  take  no  notice  of  them  or  who  threaten  them. 
M.  Magnan  has  produced  experimentally  very  vivid  hallucina- 
tions in  dogs  by  injecting  alcohol  into  their  veins :  the  animal 
starts  up,  stares  wildly  at  the  bare  wall,  barks  furiously,  and 
seems  to  rush  into  a  combat  with  an  imaginary  dog ;  after  a  while 
it  ceases  to  fight,  retires,  growling  once  or  twice  in  the  direction 
of  its  discomfited  adversary,  and  settles  down  quietly. 

So  soon  as  we  have  recognised  the  existence  of  insanity  which 
is  mainly  sensorial,  w^e  become  sensible  of  the  value  of  the  dis- 
tinction. Not  only  does  it  furnish  an  adequate  interpretation  of 
the  violent  phenomena  of  the  insanity  of  the  animal  and  of  the 
infant,  but  it  alone  sufdces  to  explain  that  desperate  fury  which 
sometimes  follows  a  succession  of  epileptic  attacks  in  the  human 
subject.  When  the  furious  epileptic  maniac  strikes  and  injures 
whatsoever  and  w^homsoever  he  meets,  and,  like  some  destructive 
tempest,  storms  through  a  ward  with  convulsed  energy,  he  has 
no  notion,  no  consciousness,  of  what  he  is  doing;  to  all  intents 
and  purposes  he  is  an  organic  machine  set  in  the  most  destruc- 
tive motion ;  all  his  energy  is  absorbed  in  the  convulsive  explo- 
sion. And  yet  he  does  not  rage  quite  aimlessly,  but  makes  more 
or  less  determinate  attacks  upon  persons  and  things :  he  sees 
\Ahat  is  before  him  and  destroys  it;  there  is  that  method  in  his 
madness  ;  his  convulsive  fury  is  more  or  less  co-ordinate.  His 
desperate  deeds  are  respondent  to  morbid  sensations  in  which  his 
consciousness  is  entirely  engulfed ;  often  there  exist  terrible 
hallucinations,  such  as  blood-red  flames  before  the  eyes,  loud 
roaring  noises  or  imperative  voices  in  the  ears,  sulphurous  smells 
in  the  nostrils  ;  any  real  object  which  does  present  itself  before 


262  PATHOLOGY  OF  MIND.  [chap. 

the  eyes  is  seen  with  the  strangest  and  most  unreal  characters  ; 
lifeless  objects  seem  to  threaten  his  life,  and  the  pitying  face  of 
a  friend  becomes  the  menacing  face  of  a  devil.  His  frantic 
deeds  therefore  do  not  answer  to  the  realities  around  him,  but 
to  the  unreal  surroundings  which  his  sensorial  anarchy  has 
created :  ^  they  are  the  motor  exponents  of  his  fearful  hallucina- 
tions. For  the  time  being  there  is  a  true  sensorial  insanity,  the 
functions  of  higher  nervous  centres  being  in  abeyance;  and 
after  the  frantic  paroxysm  is  over  there  is  complete  forgetful- 
ness  of  what  has  happened  during  it,  as  there  is  forgetfulness  of 
sensori-motor  action  in  health.  Differences  between  this  epi- 
leptic fury  and  infantile  insanity  arise  out  of  the  residua,  sensory 
and  motor,  which,  wanting  in  the  child,  have  been  acquired  and 
organised  through  experience  in  the  nerve  centres  of  the  adult : 
the  sensory  residua  render  possible  in  the  adult  special  halluci- 
nations which  the  infant  cannot  have  ;  wdiile  the  residua  in  the 
motor  centres  which  are  the  basis  of  the  secondary  automatic 
faculties  render  possible,  in  like  manner,  a  degree  and  variety 
of  violence  w^hich  the  infant,  possessing  only  such  germs  of 
co-ordinate  function  as  are  original,  must  needs  fall  short  of. 

The  transformation  of  disordered  sensation  into  disordered 
movement  is  not  so  quick  and  violent  in  all  cases.  As  the 
child  adds  day  by  day  to  the  number  of  its  definite  perceptions, 
and  accumulates  the  materials  of  reflection,  the  distractincj  and 
inhibitory  operations  of  wiiich  come  into  play,  there  is  a  less 
strong  tendency  to  instant  motor  expression  of  sensory  states. 
Hallucinations  may  therefore  come  and  go,  or  persist  for  a 
time,  without  provoking  any  violent  movements.  I  might 
indeed,  justly  distinguish  two  classes  of  cases :  one  class  in 
wdiich  a  violent  and  convulsive  reaction,  the  result  of  the  in- 
stant transformation  of  impressions  into  mxOvement,  masks  all 
other  features  of  the  disease,  and  gives  it  an  e'pilcptiform  charac- 
ter ;  another  class  in  which  the  active  sensory  residua  persist  in 

1  An  epileptic,  under  my  care,  usually  a  mild  and  gentle  being-,  used  to 
become  a  most  violent  and  dangerous  maniac  after  a  series  of  tits,  and  to 
commit  terrible  destruction.  He  thought  at  these  times  that  he  waa 
fighting  for  his  life  against  a  lion,  and  his  desperate  actions  were  the 
exponents  of  his  mental  chaos. 


VI.]  THE  INSANITY  OF  EARLY  LIFE.  263 

consciousness  as  hallucinations,  giving  rise,  if  they  give  rise  to 
answering  movements,  to  such  as  are  more  cJioreic  in  character. 

A  variety  of  insanity  in  children,  then,  which  we  may  next 
consider,  is  that  form  of  sensorial  insanity  in  which  hallucina- 
tions occur,  and  in  which  the  motor  reactions  are  not  convulsive 
and  epileptiform,  but  spasmodic  rather  and  choreic.  There  is 
reason  to  think  that  temporary  or  fugitive  hallucinations  are 
not  uncommon  in  infancy,  and  that  the  child  when  stretching 
out  its  hand  and  appearing  to  grasp  at  an  imaginary  object  is 
deceived  sometimes  by  a  subjective  sensation  which  has  been 
excited  by  an  internal  bodily  state,  just  as  a  smile  or  a  frown 
on  its  face  is  excited  oftentimes  by  a  purely  bodily  state.  Ex- 
perimental proof  of  this  manner  of  origin  is  not  wanting :  Dr. 
There  mentions  the  case  of  an  infant,  aged  fourteen  months  and 
a  half,  which  had  accidentally  been  poisoned  by  the  seeds  of 
the  Batura  stramonium,  a  drug  which,  like  belladonna,  is  well 
known  to  disorder  the  sensory  centres ;  hallucinations  of  sight 
occurred,  as  shown  by  the  motions  of  the  child,  which  seemed 
to  be  constantly  seeking  for  some  imaginary  objects  in  front  of 
it,  stretching  out  its  hands  and  clinging  to  the  sides  of  the 
cradle  in  order  to  reach  them  better.^  The  most  remarkable 
example  of  such  condition  of  hallucination  is  afforded,  how- 
ever, by  that  form  of  nightmare  which  some  children  suffer  so 
much  from :  possessed  with  a  vivid  hallucination,  they  begin 
to  shriek  out  in  the  greatest  terror  without  being  awake,  though 
their  eyes  are  wide  open ;  they  tremble  or  are  almost  convulsed 
with  fright,  and  do  not  recognise  their  parents  or  others  who 
attempt  to  calm  them ;  and  it  is  some  time  before  the  paroxysm 
subsides  and  they  can  be  pacified.  In  the  morning  they  know 
nothing  of  the  fright  which  they  had,  but  have  forgotten  it,  as 
the  somnambulist  forgets  his  midnight  walk,  or  as  sensation  is 
commonly  forgotten.  Strictly  speaking,  however,  it  is  not  right 
to  say  that  they  forget  the  experience,  because  the  activity  wa-s 
all  the  while  sensorial ;  and  as  there  was  no  conscious  perception, 
as  the  child  did  not  perceive  that  it  perceived,  there  could  be 
no  conscious  memory.  The  undoubted  and  not  uncommon  occur- 
rence of  these  vivid  hallucinations  in  children,  when  the  matter 

^  Annales  Medico-Ps?/cJiolo(jig[ue,  18-19. 


264  PATHOLOGY  OF  MIND.  [uuap. 

has  certainly  passed  beyond  ordinary  dreaming,  will  serve  to 
show  how  probable  it  is  that  they  have  sometimes,  when  awake, 
positive  hallucinations.  And  if  a  very  young  child  is  affected 
with  hallucinations,  it  cannot  help  believing  in  them  any  more 
than  the  dreamer  can ;  it  cannot  correct  sense  by  reflection, 
since  the  higher  nervous  centres  of  thought  have  not  yet  entered 
upon  their  function.  They  may  therefore  exist  temporarily 
in  children  without  indicating  any  serious  disturbance  of  the 
health ;  the  organic  residua  of  a  sensation  being  stimulated  to 
activity  by  some  trifling  and  transient  bodily  derangement. 

It  is  in  conformity,  then,  with  pathological  observation  as 
well  as  with  physiological  principles,  to  affirm  the  existence  in 
children  of  a  variety  of  sensorial  insanity  which  is  characterised 
by  hallucinations,  most  frequently  of  vision,  and  sometimes  by 
answering  irregular  movements.  Fits  of  involuntary  laughter 
are  often  witnessed  in  such  cases  :  the  laugh,  or  rather  smile,  of 
the  infant  is  an  involuntary  sensori-motor  movement,  before  it 
has  any  notion  of  the  meaning  of  the  smile  or  any  consciousness 
that  it  is  smiling ;  consequently  we  meet  with  an  irregular  and 
convulsive  manifestation  of  this  function  as  the  motor  expres- 
sion of  a  morbid  state  of  things.  Dr.  Whytt  relates  the  instance 
of  a  boy,  aged  10,  who,  in  consequence  of  a  fall,  had  violent 
])aroxysmal  headaches  for  many  days.  After  a  time  there 
occurred  **  fits  of  involuntary  laughter,  between  which  he  com- 
plained of  a  strange  smell  and  of  pins  prickiiig  his  nose ;  he 
talked  incoherently,  stared  in  an  odd  manner,"  and  immediately 
afterwards  fell  into  convulsions.  He  recovered  on  this  occasion, 
but  two  years  afterwards  was  similarly  attacked :  he  had  severe 
headache,  saw  objects  double,  and  suffered  from  a  severe  pain  in 
the  left  side  of  his  belly,  confined  to  a  spot  not  larger  than  a 
shilling;  "soinetimes  it  shifted,  and  then  he  was  seized  with 
fatiguing  fits  of  involuntary  laughter."  Ultimately  he  recovered 
partially,  but  never  completely.^  One  ought  to  take  particular 
pains  in  all  cases  of  hallucination  in  children  to  make  a  close 
examination  of  the  state  of  the  general  sensibility  of  the  body  ; 
for  perversions  or  defects  of  it  will  frequently  be  found  both 
where  there  are  corresponding  perversions  of  movements  and 

^  Op.  cii.  p.  144. 


VI.]  THE  INSANITY  OF  EARLY  LIFE.  265 

where  there  are  not.  Because,  however,  this  form  of  sensorial 
insanity  is  often  associated  with  movements  of  a  more  or  less 
choreic  character,  and  because,  as  compared  with  the  previously- 
illustrated  epileptiform  variety,  it  has  relations  not  unlike  those 
which  chorea  has  to  epilepsy,  I  have  described  it  as  the  choreic 
variety  of  sensorial  insanity. 

AVith  each  succeeding  presentation  of  an  object  to  a  child 
the  impressions  made  on  the  different  senses  by  it  are  more 
exactly  felt  and  more  perfectly  combined,  so  that  an  adequate 
idea  of  the  object  is  at  last  organised  in  the  liigher  ideational 
centres ;  there  is  a  consilience  of  the  sensory  impressions  into 
the  idea,  which  thenceforth  makes  it  possible  for  the  child  to 
think  of  the  object  when  it  is  not  present  to  the  senses,  or  to 
have  a  definite  and  adequate  perception  of  it  w^hen  it  is.  As 
development  proceeds,  one  idea  after  another  is  thus  added  to 
the  mind  until  many  simple  ideas  have  been  organised  in  it ; 
for  a  long  time,  however,  these  ideas  remain  more  or  less  isolated 
and  imperfectly  developed  ;  there  are  not  definite  and  complete 
associations  between  them,  expressing  their  relations,  and  the 
child's  discourse  is  consequently  incoherent ;  there  is  not  more- 
over a  complete  organisation  of  residua  at  first,  and  its  memory 
is  consequently  fallacious.  Children,  like  brutes,  live  in  the 
present,  their  happiness  or  misery  being  dependent  upon  im- 
pressions made  upon  the  senses :  the  idea  or  emotion  excited 
does  not  remain  in  consciousness  and  call  up  other  ideas  and 
emotions,  so  modifying  the  sense  of  present  pleasure  or  pain 
by  memories  of  what  has  been  felt  before,  wdiich  may  tend  to 
inhibit  action,  but  it  is  directly  uttered  in  outward  action. 
Such  a  con^lition  of  development,  which  is  natural  to  the  child 
before  the  fabric  of  its  mental  organisation  has  been  built  up, 
and  to  the  animal,  in  which  the  constitution  of  the  nervous 
system  renders  a  higher  mental  development  impossible,  would, 
w^ere  it  met  wdth  in  an  European  adult,  represent  idiocy,  or  an 
arrest  of  mental  development  from  morbid  causes. 

So  soon  as  definite  ideas  have  been  organised  in  the  child's 
mind  delusions  are  possible.  But  as  ideas  are  at  first  compara- 
tively few  in  number,  and  as  their  organic  associations  are  very 
imperfect,  a  derangement  of  the  function  of  their  centres  must 


266  PATHOLOGY  OF  MIND.  [ciiap. 

needs  be  characterised  by  very  incoherent  delirium.  Divers 
morbid  ideas  will  spring  np  without  coherence ;  and  the  morbid 
phenomena,  wanting  system,  will  correspond,  not  so  much  with 
those  which  in  the  adult  we  describe  as  mania,  where  there  is 
a  more  or  less  systematized  derangement,  some  method  in 
the  madness,  as  with  those  which  are  known  as  delirium, 
when  ideas  sx^ontaneously  arise  in  consciousness  in  the  most 
incoherent  way.  Let  me  proceed  then  to  test  these  principles 
by  an  examination  of  such  facts  as  are  available. 

As  a  morbid  idea  in  the  child's  mind  has,  by  the  nature  of 
the  case,  but  a  small  range  of  action  upon  other  ideas,  it  tends 
to  utter  itself  by  its  other  paths  of  expression ;  namely,  by  a 
downward  action  upon  the  sensory  ganglia  or  upon  the  move- 
ments. When  it  acts  downwards  upon  the  sensory  ganglia  it 
gives  rise  to  a  hallucination ;  and  in  such  cases,  as  may  easily  be 
imagined,  it  will  not  always  be  possible  to  determine  whether 
the  hallucination  is  really  secondary  or  primary — whether,  that 
is  to  say,  it  is  engendered  indirectly  by  the  action  of  the  morbid 
idea  upon  the  sensory  ganglion,  or  directly  by  the  excitation  of 
the  sensory  residua  by  some  organic  irritation.  If  a  child  which 
is  only  a  few  years  old  sees  strange  figures  of  some  sort  on  the 
wall,  which  have  no  real  existence,  but  disappear  with  apparently 
as  little  reason  as  they  came  there,  the  hallucinations  are  most 
likely  owing  to  some  organic  cause  of  disturbance  which  affects 
directly  the  sensory  ganglia.  But  if  a  child  of  eight  or  nine 
years  old,  whose  head  has  been  filled  with  foolish  and  dangerous 
notions  concerning  the  devil,  or  who  has,  when  naughty,  been 
threatened  by  its  nurse  with  the  terrors  of  a  black  man  who 
will  come  and  carry  it  off,  suddenly  sees  a  devil  or  a  black  man 
appear  and  shrieks  in  terrified  agony,  then  the  hallucination  is 
secondary  to  the  recklessly  implanted  delusion.  Doubtless  this 
sort  of  idea-produced  hallucination  occurs  frequently  enough 
in  those  nightmares  of  children  which  have  been  already 
mentioned. 

The  secondary  generation  of  hallucinations  again  is  strikingly 
illustrated  by  the  occurrence  of  phantasms  before  the  eyes  of 
certain  precocious  children  of  nervous  temperament  who  create 
for  themselves  scenes  and  dramas  which  appear  to  be  visible 


Yi.]  THE  INSANITY  OF  EARLY  LIFE.  267 

representations  of  the  thouglits  that  are  passing  through  their 
minds:  what  they  think,  that  they  actually  see,  just  as  the 
dreamer  does.  Accordingly  a  sort  of  drama  is  represented 
before  their  eyes  in  which  they  take  their  part,  and  they  live  for 
the  time  in  a  scene  which  is  purely  visionary  as  though  it  were 
quite  real.  "  What  nonsense  you  are  talking,  child ! "  the 
mother  perhaps  exclaims  ;  and  thereupon  the  pageant  vanishes. 
Or  they  talk  of  imaginary  scenes  of  the  kind  as  if  they  had 
actually  occurred,  and  are  accused  of,  or  even  punished  for,  false- 
hood in  consequence  :  not  always  wisely,  seeing  that  on  account 
of  the  vividness  of  the  hallucinations  and  the  absence  of  a 
store  of  registered  ideas  in  their  minds  they  are  more  apt  to 
believe  them  real  events,  and  less  qualified  to  correct  them,  than 
older  persons  are.  In  delicate  and  highly  nervous  children, 
predisposed  to  or  affected  with  meningeal  tubercle,  it  sometimes 
happens  that  great  anxiety  is  caused  to  the  mother  by  the 
strange  way  in  which,  during  the  night,  when  outer  objects  are 
shut  out  by  the  darkness,  they  will  talk  as  if  they  were  sur- 
rounded by  real  events,  or,  as  the  mother  perhaps  puts  it,  as  if 
they  were  light-headed.  They  are  dreaming  while  they  are 
awake ;  though  the  outer  world  is  shut  out,  the  morbid  deposit 
within  acts  as  an  irritating  stimulus  to  the  ganglionic  nervous 
centres,  and  thus  gives  rise  to  an  automatic  activity  of  them. 
In  one  case,  which  came  under  my  notice,  of  a  scrofulous  child 
with  large,  irregularly  formed  head,  terrific  visions  of  the  kind 
occurred  in  the  night  when  it  was  wide  awake.  It  would 
shriek  out  in  fright,  exclaiming  that  there  was  something  in  the 
bed.  The  moonlight  was  especially  obnoxious  to  it,  because,  it 
said,  *'it  makes  so  much  noise."  There  was  a  weH-marked 
frown  on  the  forehead  when  it  looked  towards  the  window  or 
the  light — a  less  degree  of  the  photophobia  which  occurs  in 
tubercular  meningitis.  These  children  of  a  tubercular  tempera- 
ment are  sometimes  extremely  precocious  in  mind ;  so  much  so 
that  old  women  shake  their  heads  gravely,  and  justly  remark 
that  they  are  too  forward  to  live.  They  show  excessive 
nervous  apprehension  in  one  way  or  another,  and  at  the  same 
time  perhaps  an  extraordinary  absence  of  natural  fear  in  another 
relation :   one  delicate  little  creature  used  to  shriek  with  fridit 

o 


268  PATHOLOGY  OF  MIND.  [chap. 

if  another  child  or  a  dog  came  towards  it  in  tlie  street,  and  yet 
delighted  in  a  stormy  wind,  no  matter  how  high ;  and  another 
child  would  go  up  instantly,  wit^iout  the  least  fear,  to  any  strange 
dog  that  it  met  and  seize  hold  of  it,  never  coming  to  harm. 

Hallucinations  may  undoubtedly  be  fugitive  events  in  the 
history  of  any  child  endowed  with  a  highly  nervous  tempera- 
ment, as  in  William  Blake,  the  engraver,  and  may  not  denote 
any  positive  disease  ;  but  if  the  habit  grows  upon  the  child  by 
indulgence,  and  the  phantasms  are  regularly  marshalled  into  a 
definite  drama, — as,  for  example,  was  the  case  with  Hartley 
Coleridge, — then  a  condition  of  things  is  initiated  which  will  in 
all  likelihood  issue  ultimately  in  some  form  of  mental  disorder.^ 
For  it  is  not  the  natural  course  of  mental  development  that 
ideas,  so  soon  as  they  are  fashioned  in  the  mind,  should  operate 
directly  downwards  upon  the  sensory  ganglia,  and  thus  create  a 
visionary  world ;  on  the  contrary,  it  is  necessary  to  the  progress 
of  mental  development  that  ideas  should  be  completely  organ- 
ised within  the  centres  of  consciousness,  and  act  upon  one 
another  there ;  that  thus,  by  the  integration  of  the  like  in 
perceptions  and  the  differentiation  of  the  unlike,  accurate  con- 
ceptions of  nature  should  be  formed  and  duly  associated  in  the 
mental  fabric;  and  that  the  reaction  upon  external  nature 
should  be  a  definite,  aim-working,  volitional  one.  Men  like 
Hartley  Coleridge  cannot  have  a  will,  because  the  energy  of 
their  supreme  nervous  centres  is  prematurely  expended  in  the 
construction  of  toy-works  of  the  fancy ;  the  state  of  things 
corresponding  in  some  sort  with  that  which  obtains  in  the 
spinal  centres  when,  by  reason  of  an  instability  of  nerve  ele- 
ment, direct  reactions  take  place  to  impressions,  so  that  definite 
assimilation  and  acquired  co-ordination  are  rendered  impossible. 
In  both  cases  an  arrest  of  right  development,  commonly 
the  forerunner  of  more  active  disease,  is  indicated;  in  both 
cases  there  is  the  incapacity  for  a  true  education.     The  pre- 

^  *'  Blake's  first  vision  was  said  to  be  wlien  he  was  eight  or  ten  years 
old  ;  it  was  a  vision  of  a  tree  filled  with  angels.  Mrs.  Blake,  however, 
used  to  say — *  You  know,  dear,  the  first  time  you  saw  God  was  when  you 
were  four  years  old,  and  He  put  His  head  to  the  window  and  set  you 
screaming.'  " — Gilchrist's  Life  of  Blake. 


VI.]  THE  INSANITY^  OF  EARLY  LIFE.  269 

cocious  imagination,  or  rather  fancy,  of  childhood  sliould  be 
checked  as  a  danger  rather  than  fostered  as  a  wonderful  evidence 
of  talent ;  the  child  being  solicited  and  trained  to  regular  inter- 
course with  the  realities  of  nature,  so  that  by  continued  internal 
adaptation  to  external  impressions  there  may  be  laid  up  in  the 
mind  good  stores  of  material,  and  that,  by  an  orderly  training, 
this  may  be  moulded  into  true  forms,  according  to  which  a 
rightly  informed  imagination  may  hereafter  work  in  true  and 
sober  harmony  with  nature. 

The  ditference  between  fancy  a,nd  imagination,  as  Coleridge 
aptly  remarked,  corresponds  with  the  difference  between  delirium 
and  mania.  The  fancy  brings  together  whimsically  images 
which  have  no  natural  connection,  but  which  it  yokes  together 
by  means  of  some  accidental  coincidence,  so  making  creations 
that  are  oftentimes  essentially  inconsistent  or  untrue  ;  while  the 
imagination  combines  images  like  or  unlike,  by  their  essential 
relations,  and  so  gives  unity  to  variety.  Xow  the  precocious 
imagination  of  a  child,  which  is  sometimes  the  delight  of  foolish 
parents,  cannot  possibly  be  anything  more  than  lying  fancy  ; 
and  this  for  exactly  the  same  reason  that  the  insanity  of 
children  must  be  a  delirium  and  cannot  be  a  mania — the  in- 
complete formation  of  adequate  ideas  and  the  absence  of 
definitely  organised  associations  between  them.  Those,  there- 
fore, who  consider  closely  and  without  prepossession  the  funda- 
mental meanincr  of  the  character  which  the  delirium  of  children 
has,  will  not  fail  to  perceive  in  it  the  strongest  evidence  of  the 
gradual  organisation  of  mind ;  the  fancy  of  the  sane  and  the 
delirium  of  the  insane  child  both  testifying  to  the  same  condi- 
tion of  thinsjs — that  which  the  habitual  incoherence  of  a  child's 
discourse  also  evidences. 

In  order  to  set  forth  clearly  the  manner  of  action  of  morbid 
idea  in  children,  and  to  educe  therefrom  a  physiological  lesson, 
its  operation  has  been  artificially  separated  from  other  morbid 
phenomena  which  usually  accompany  it.  In  young  children  it 
is  practially  rare  to  meet  with  disorder  limited  to  the  supreme 
nervous  centres  ;  the  other  .centres  are  almost  certain  to  be  more 
or  less  affected.  In  chorea,  for  example,  besides  the  disordered 
movements  which  are  its  common  characteristic,  there  may  be 


270  PATHOLOGY  OF  MIND.  [chap. 

hallucinations  marking  disorder  of  the  sensorial  centres,  and 
motiveless  weeping  or  laughing,  or  acts  of  mischief  and  violence, 
marking  disorder  of  some  of  the  higher  motor  centres  ;  there  are 
furthermore  in  some  cases  mental  excitement  and  incoherence, 
which  may  pass  into  maniacal  delirium  and  end  fatally,  or  into 
chronic  delirium  and  end  in  recovery.  The  different  nerve 
centres  sympathise  with  one  another;  and,  according  as  they 
minister  to  ideation,  sensation,  or  movement,  express  their 
disorder  in  delirium,  hallucination,  or  spasmodic  movements. 

Having  treated  of  the  phenomena  of  mental  derangement  in 
young  children  generally  from  a  pathological  point  of  view,  I 
now  go  on  to  arrange  in  suitable  groups  the  different  forms  that 
are  met  with  in  practice. 

Corresponding  with  the  principal  varieties  of  motor  dis- 
order that  occur  in  children  as  in  adults,  three  nearly  allied 
groups  of  mental  disorders  might  be  described  and  called  respec- 
tively choreic  insanity,  catal&ptoid  insanity ,  and  cpiUjgtic  insanity. 
They  are  not  of  course  distinctly  separate  groups,  since  inter- 
mediate cases  between  one  group  and  another  prevent  a  plain 
line  of  division  being  made,  but  the  greater  number  of  cases  in 
each  group  have  common  characters  which  render  it  convenient 
to  bring  them  together. 

Choreic  Insanity. — There  is  a  choreic  mania  sometimes  met 
with  in  children  which  appears  to  be  the  exact  counterpart  of 
the  choreic  spasms  that  occur.  What  is  sufficiently  striking, 
even  to  an  ordinary  observer  of  this  mania,  is  its  marked  in- 
coherence and  its  manifestly  automatic  character.  It  seems  as  if 
the  connections  of  tlie  primary  nerve  centres  had  been  dislocated, 
and  as  if  each  centre  were  acting  on  its  own  account,  giving  rise 
thereby  to  a  sort  of  mechanically  repeated  and  extremely  inco- 
herent delirium.  A  boy  of  about  eleven  years  of  age,  who  came 
under  my  care,  was,  after  a  slight  and  not  distinctly  described 
sickness,  suddenly  attacked  with  this  form  of  delirium;  he 
moved  about  restlessly,  throwing  his  arms  about  and  repeating 
over  and  over  again  such  expressions  as — "  The  good  Lord 
Jesus,"  "  They  put  Him  on  the  cross,"  "  They  nailed  His  hands," 
&c.  It  was  impossible  to  fix  his  attention  for  a  moment ;  for 
he  turned  away  when  the  attempt  was  made,  wandered  aimlessly 


VL]  THE  INSANITY  OF  EAELY  LIFE.  271 

about,  pointing  to  one  hand  and  then  to  the  other,  and  babbling 
his  incoherent  utterances.  So  far  as  could  be  made  out,  there  was 
considerable  insensibility  of  the  skin  over  certain  parts  of  the 
body,  as  there  commonly  is  in  this  form  of  insanity.  In  two 
days,  after  appropriate  treatment,  the  delirium  passed  off,  and 
the  boy  was  quite  himself  again.  I  once  saw  an  interesting 
case  of  insanity  in  a  girl,  get.  fourteen,  who  w^as  lively,  pretty, 
and  intelligent.  From  time  to  time  she  would  suddenly  jump 
up  in  the  evening  in  a  paroxysm  of  excitement,  exclaiming, 
"Mother,  I'm  dying!"  and  begin  praying  frantically  in  a 
mechanical  manner.  The  paroxysm  lasted  for  three  or  four 
hours,  and  left  her  pale,  cold,  exhausted,  and  trembling  like  a 
leaf.  A  brother  had  died  after  being  similarly  afflicted.  When 
I  saw  her  she  looked  somewhat  strange  and  was  forgetful ;  she 
used  to  imagine  sometimes  too  that  she  saw  the  bed  on  fire  and 
dead  bodies  on  the  ground,  knowing  all  the  while  that  the 
visions  were  hallucinations.  The  mother  suffered  for  months  at 
one  time  from  speechless  melancholia,  and  nearly  all  her  family 
had  died  from  phthisis.  She  had  had  fourteen  miscarriages, 
and  three  children  who  died  at  early  ages,  this  girl  being  the 
only  one  left ;  when  pregnant  with  her  she  had  a  terrible  fright 
from  seeing  one  child  accidentally  killed,  and  the  girl  was  born 
affected  with  constant  choreic  movements,  which  continued 
until  six  months  after  birth.  Before  the  paroxysms  of  mental 
excitement  came  on,  she  had  been  subject  to  periodical  attacks 
of  depression,  in  which  she  would  cry  for  hours ;  and  all  her  life 
she  had  suffered  more  or  less  from  pain  in  the  head,  especially 
in  the  left  temple,  with  paroxysmal  exacerbations  thereof. 

A  boy,  aged  twelve,  was  admitted  into  the  Devon  Asylum, 
who  had  been  afflicted  all  his  life  to  some  extent  with  chorea 
A  few  days  before  admission  he  had  attempted  to  hang  himself, 
and  there  was  the  mark  made  by  the  rope  upon  his  neck.  On 
admission  he  was  acutely  maniacal,  attempted  to  dash  his  head 
against  the  walls,  and,  when  put  in  the  padded  room,  lay  on  the 
floor,  crying — "  Oh,  do  kill  me !  Dash  my  brains  out !  Oh,  do 
let  me  die  ! "  He  kicked  and  bit  the  attendants,  and  tried  in 
every  way  to  kill  himself:  his  head  was  hot,  his  pulse  quick. 


272  PATHOLOGY  OF  MIXD.  [chap. 

he  refused  food,  and  did  not  sleep.     He  completely  recovered 
under  proper  treatment  after  a  few  days.^ 

The  most  striking  example  of  mental  derangement  in  a  child 
which  ]\Iorel  ever  saAv  was  in  a  little  girl,  ?et.  eleven,  who,  after 
tlie  sudden  disappearance  of  a  disease  of  the  skin,  suffered  from 
choreic  movements,  and  soon  afterwards  was  attacked  with  a 
maniacal  fury.  She  attempted  to  kill  her  mother,  and  nearly 
drowned  one  of  her  sisters  by  throwing  her  into  a  pond  of 
water.  In  her  paroxysms  she  displayed  a  strength  almost 
incredible,  and  it  is  scarcely  possible  to  communicate,  says 
Morel,  an  adequate  idea  of  the  destructive  tendencies  of  this 
little  being.  She  recovered  after  a  fever  when  all  medical  treat- 
ment had  failed. 

These  cases  will  suffice  as  illustrations  of  choreic  insanity.  It 
is  only  necessary  to  bear  in  mind  that,  as  with  choreic  move- 
ments every  degree  of  convulsive  violence  is  met  with  in 
different  cases,  so  with  choreic  mania  every  degree  of  excite- 
ment and  incoherence  is  met  with.  Hallucinations  of  the 
special  senses  and  perversions  of  general  sensibility  frequently 
accompany  the  delirium. 

Catalejptoid  Insanity. — Another  form  which  insanity  takes 
sometimes  in  childhood  is  that  of  a  more  or  less  complete 
ecstasy ;  and  this  may  be  fitly  described  as  the  cataleptoid 
variety.  It  generally  occurs  in  young  children.  The  little  patient 
lies  perhaps  for  hours  or  days  seemingly  in  a  sort  of  mystical 
abstraction,  with  limbs  more  or  less  rigid,  or  fixed  in  strange 
postures ;  sometimes  there  is  insensibility  to  impressions,  while 
in  other  instances  vague  answers  are  given,  or  there  is  utterly 
incoherent  raving,  with  sudden  outbursts  of  wild  shrieks  from 
time  to  time.  These  attacks  are  of  variable  duration,  and  are 
repeated  at  varying  intervals.  They  would  seem  to  represent 
a  sort  of  spasm  of  certain  nervous  centres  engrossing  the  whole 
nervous  energy,  so  that  for  the  time  being  the  body  becomes  an 
automatic  instrument  of  their  exclusive  activity,  all  voluntary 
power  being  in  abeyance.  While,  on  the  one  hand,  there  are 
intermediate  conditions  between  this  form  of  disease  and  chorea, 
its  attacks,  on  the  other  hand,  sometimes  alternate  with  true 

^  Manual  of  Psychological  ATedicine^  by  Drs.  Hack  Tuke  and  Bucknill, 


V1.J  THE  INSANITY  OF  EARLY  LIFE.  273 

epileptic  seizures,  and  at  other  times  pass  gradually  into  tlieni : 
it  represents  a  class  of  hybrid  seizures  that  stand  midway 
between  chorea  and  epilepsy.  In  a  girl  who  came  under  Dr. 
West's  treatment  at  the  age  of  ten  years  and  ten  months,  there 
had  been  first  an  attack  of  general  convulsions  without  any 
obvious  cause,  when  she  was  eight  years  old.  Afterwards  she 
was  subject  to  occasional  attacks  of  great  excitement  of  behaviour, 
and  for  six  months  there  w^as  a  sort  of  cataleptic  state  in  wdiich 
she  stood  immovable  for  one  or  two  minutes,  staring  wildly  or 
fixedly,  and  murmuring  unconnected  'svords  that  had  reference 
to  any  object  w^hich  she  might  happen  to  see.  About  eleven 
months  from  the  commencement  of  these  attacks  their  charac- 
ter changed ;  they  became  truly  epileptic,  the  child's  conduct 
in  the  intervals  between  the  seizures,  though  sometimes  quite 
reasonable,  having  mostly  something  insane  about  it.^  The 
example  shows  the  close  relations  of  disorders  of  the  different 
nervous  centres  in  children,  their  hybrid  nature  at  times,  and 
the  artificial  character  of  the  divisions  usually  made  between 
them. 

EpihiJtic  Insanity. — ISTot  only  are  the  different  forms  of 
epilepsy  met  with  in  children,  but  also  the  different  forms  of 
insanity  that  occur  in  connection  with  epilepsy.  The  xjetit  mal 
sometimes  lasts  for  many  months  in  children,  and  then  passes 
into  regular  attacks  of  convulsive  epilepsy  ;  its  usual  effect 
being  to  produce  loss  of  memory  and  more  or  less  imbecility  of 
mind.  But  whether  epilepsy  in  children  has  the  less  patent 
form  of  vertigo  or  the  declared  form  of  regular  convulsions, 
there  is  always  great  danger  that  it  wdll  occasion  an  arrest  of 
that  cerebral  development  which  is  the  basis  of  a  good  mental 
organisation.  In  the  case  of  a  young  girl,  aged  eight  years, 
of  good  ph3^sical  conformation,  who  came  under  my  care, 
epilepsy  seemed  to  have  produced  an  arrest  of  mental  develop- 
ment at  the  sensorial  stage :  she  was  a  most  mischievous  little 
machine,  never  quiet,  ranning  about  aimlessly  and  seizing,  or 
attempting  to  seize,  whatever  she    saw ;  nowise  content  with 

1  "Ueber  Epilepsie  Blodsinn  und  Irrsein  der  Kinder,"  von  Charles  West, 
M.D. — Journal  fur  Kinderkrankheiten,  vol.  xxiii.  1854.  See  also  a  paper 
by  M.  Delasiauve  ki  Annales  Midico-Psychologlque^  vol.  vii.  1855. 


274  PATHOLOGY  OF  MIND.  [ceaf. 

what  she  caught  hold  of,  but  throwing  it  down  directly  she  had 
got  it,  and  struggling  for  something  else  which  drew  her  notice ; 
not  in  the  least  amenable  to  correction  or  instruction,  and  de- 
manding the  whole  energies  of  one  person  to  look  after  her. 
She  was  an  automatic  machine  incited  by  sensory  impressions 
to  mischievous  and  destructive  acts. 

As  in  adults,  so  in  children,  an  attack  of  violent  mania,  a 
furor  trmisitorius,  may  precede,  or  take  the  place  of,  or  follow 
an  attack  of  epilepsy,  being  in  reality  a  sort  of  mental  epilepsy. 
When  the  mania  takes  the  place  of  the  epileptic  attack,  oc- 
curring in  its  stead,  it  is  described  sometimes  as  a  masked 
epilepsy — epilepsie  larvSe.  Children  of  three  or  four  years  old 
are  sometimes  seized  with  sudden  attacks  of  violent  shriekincj, 
desperate  stubbornness,  or  furious  rage,  when  they  bite,  tear, 
and  destroy  whatever  they  can ;  these  seizures  come  on  periodi- 
cally, and  may  either  pass  in  the  course  of  a  few  months  into 
regular  epilepsy,  or  may  be  found  to  alternate  with  epileptic 
attacks.  They  are  a  sort  of  vicarious  epilepsy.  Morel  has  met 
with  two  cases  in  which  children  fell  into  convulsions  and  lost 
the  use  of  speech  in  consequence  of  a  great  fear ;  afterwards  a 
maniacal  fury,  with  tearing,  destroying,  and  continual  turbu- 
lence, occurred :  in  one  case,  the  child  being  ten  years  and  a 
half  old,  epilepsy  followed ;  in  the  other  child,  aged  five  years, 
it  did  not.^  One  of  the  boys  in  a  school  was  attacked  in  the 
night,  without  evident  cause,  with  a  sudden  furor  transitorius  : 
he  rushed  wildly  up  and  down  the  dormitory,  speaking  loudly 
but  inarticulately,  so  that  another  of  the  pupils  got  up  to  quiet 
him  ;  but  he  seized  the  latter  with  great  violence,  and,  but  for 
the  interference  of  others,  would  have  strangled  him.  With 
some  difficulty  he  was  got  to  bed;  a  true  epileptic  attack 
followed  ;  and  in  the  morning  he  knew  nothing  whatever  of 
what  had  happened,  but  felt  weary  and  exhausted.^  Dr.  Ludwig 
Meyer,  w^ho  relates  this  case,  relates  another  case  of  a  boy,  set. 
13,  who  was  subject  to  periodical  attacks  of  fury,  followed  by 

1  Traite  des  Maladies  Mentales,  1860,  p.  102.  He  relates  also  the  before- 
mentioned  case  of  the  girl,  get.  11,  who  had  furious  maniacal  attacks,  during 
which  she  attempted  to  kill  her  mother  and  injure  her  sisters. 

2  "  Ueber  Mania  Transitoria,"  von  Dr.  Ludwig  Meyer.  Virchow's  ^rcAiv, 
vol.  viii.  art.  ix. 


VI.]  THE  INSANITY  OF  EARLY  LIFE.  275 

epileptic  convulsions,  and  who  often  had  the  furious  maniacal 
excitement  without  the  convulsions,  illustrating  the  transition 
of  mania  transitoria  into  epileps}^ 

Some  writers  hold  that  when  the  mania  seems  to  occur  in  the 
stead  of  epilepsy  the  truth  is  that  it  has  been  preceded  by  an 
unobserved  attack  of  epileptic  vertigo.  No  doubt  such  an  attack 
oftentimes  passes  without  being  noticed,  but  it  is  only  a  surmise/ 
til  at  it  is  so  in  all  cases ;  and  as  the  maniacal  outbreak  which 
frequently  precedes  a  fit  may  undoubtedly  occur  sometimes 
without  a  following  fit,  why  must  it  be  sujpposed  never  to 
occur  without  a  preceding  fit  ? 

Again,  in  children,  as  in  adults,  regular  attacks  of  maniacal 
excitement  may  follow  epilepsy.  Many  such  instances  are  on 
record  ;  but  I  shall  content  myself  here  with  a  singular  example 
of  insanity,  more  cataleptoid  perhaps  than  epileptic,  following 
convulsions,  which  is  quoted  by  Griesinger  from  Kerner: — 
Margaret  B.,  set.  11,  of  a  passionate  disposition,  but  a  pious 
Christian  child,  was,  without  any  previous  illness,  seized  on 
January  19th  with  convulsive  attacks,  which  continued,  with 
few  and  short  interruptions,  for  two  days.  So  long  as  the  con- 
vulsions lasted  the  child  was  unconscious,  twisted  her  eyes, 
made  grimaces  and  strange  movements  with  her  arms  :  from 
the  21st  January  a  deep  bass  voice  proceeding  from  her  kept 
repeating  the  words,  "  They  are  praying  for  thee."  When  the 
girl  came  to  herself,  she  was  wearied  and  exhausted,  but  knew 
nothing  of  what  had  happened,  only  said  that  she  had  dreamed. 
On  the  evening  of  the  22nd  January  another  voice,  quite 
different  from  the  bass  one,  spoke  incessantly  while  the  crisis 
lasted — for  half  an  hour,  an  hour,  or  several  hours ;  and  was 
only  now  and  then  interrupted  by  the  former  bass  voice  regu- 
larly repeating  the  recitative.  The  second  voice  manifestly 
represented  a  different  personality  from  that  of  the  girl,  dis- 
tinguishing itself  in  the  most  exact  manner,  and  speaking  of 
her  in  the  third  person.  In  its  utterances  there  was  not  the 
slightest  confusion  nor  incoherence  observable,  but  all  questions 
•were  answered  by  it  coherently.  What,  however,  gave  a  dis- 
tinctive character  to  its  expressions  was  the  moral  or  rather 
immoral  tone  of  them — the  pride,  arrogance,  scorn,  and  hatred 


276  PATHOLOGY  OF  MIND.  [chap 

of  truth,  God,  Christ,  that  were  avowed.  "  I  am  the  Son  of 
God,  the  Saviour  of  the  world  :  me  ye  shall  worship,"  the  former 
voice  frequently  repeated.  Scorn  of  all  that  is  sacred,  blasphemy 
against  God  and  Christ,  violent  dislike  of  everything  good,  and 
extreme  rage  at  the  sight  of  any  one  praying,  or  even  of  hands 
folded  as  in  prayer,  expressed  by  the  second  voice — all  these, 
says  the  reporter,  might  well  betray  the  work  of  a  strange  spirit 
possessing  her,  even  if  the  pious  voice  had  not  declared  it  to  be 
the  voice  of  a  devil.  So  soon  as  this  demon  spoke,  the  fashion 
of  her  countenance  changed  in  the  most  striking  manner, 
and  assumed  a  truly  demoniacal  look.  She  ultimately  quite 
recovered,  a  voice  crying  out — "  Get  thee  out  of  this  girl,  thou 
unclean  spirit."  The  case  shows  how  naturally  would  arise  the 
once  general  but  now  abandoned  notion  that  mania  was  due  to 
possession  by  an  evil  spirit  or  devil. 

Although  the  delirium  of  childhood  is  commonly  connected 
with  some  form  of  convulsive  disease,  yet  it  sometimes  occurs 
without  convulsion,  from  other  recognised  causes  of  mania ;  in 
children  these  usually  are  blows  on  the  head,  intestinal  worms, 
and  self-abuse.  Worms  in  the  intestines,  like  other  eccentric 
irritations,  certainly  act  sometimes  upon  the  supreme  centres  to 
derange  them,  just  as  they  act  upon  the  motor  centres  to  excite 
convulsions.  Children  of  a  certain  nervous  temperament,  who 
have  plainly  inherited  a  tainted  neurosis,  now  and  then  evince 
a  singularly  active  and  precociously  vicious  sexual  tendency 
at  very  early  ages,  which  is  usually  followed  by  or  associated 
with  great  moral  perversity  and  passionate  outbreaks  of  temper 
that  are  almost  maniacal  in  some  instances.  Whatever  their 
nature,  they  are  of  bad  omen  for  the  child's  future.  Under  the 
name  oi  MmKypathie  furieuse  Guislain  describes  maniacal  attacks 
in  a  young  girl  set.  7,  which  were  due  to  caries  of  the  nose 
following  a  blow.  Other  like  cases  are  recorded  by  Haslam, 
Spurzheim,  Frank,  Burrows,  Perfect,  and  Friedreich.^  Certain 
acute  diseases,  as  for  example  typhus,  may  give  rise  to  delirium 
in  the  child  just  as  in  the  adult  during  their  course,   and  to 


^  See  also  a  paper  "  On  the  Psychical  Diseases  of  Early  Life,"  in  tlio 
Journal  of  Mental  Science^  1859,  by  Dr.  Crichton  Browne. 


VI.]  THE  INSANITY  OF  EARLY  LIFE.  277 

disorder  of  mind  during  convalescence.  In  all  these  cases  of 
mania  in  children,  however  caused,  we  shall  not  fail  to  notice  a 
mixture  of  imbecility,  due  to  their  state  of  imperfect  mental 
development,  and  of  great  moral  perversion.  And  we  may  take 
note,  if  we  will,  that  an  outbreak  of  passion  in  some  imbeciles 
is,  in  its  mental  aspect,  almost  a  temporary  mania,  and,  in  its 
physical  aspect,  a  convulsive  paroxysm. 

Affective  Derangement. — Thus  far  I  have  given  illustrations  of 
conditions  of  mental  excitement  with  incoherence  of  ideas ;  I 
now  go  on  to  notice  conditions  of  mental  depression  in  children, 
with  or  without  corresponding  morbid  impulses  and  delusions 
— cases  in  wdiich  the  affective  derangement  is  the  predominant 
symptom.  The  affective  tone  is  fundamental,  due  to  the  sympa- 
thetic system  of  the  organic  life,  and  is  the  medium  which  gives 
colour  to  the  ideas;  and  w^hile  the  more  lately  acquired  words 
are  the  language  of  ideas,  its  more  primitive  language  is  cries, 
exclamations,  modifications  of  the  tones  of  the  voice  and  of 
the  bodily  features.  It  is  by  these  that  feeling  expresses  itself 
directly  before  the  child  has  acquired  ideas ;  and  w^hen  the  child 
has  acquired  ideas  and  is  able  to  utter  them  in  w^ords,  it  still 
expresses  itself  in  the  primitive  way,  but  also  indirectly  through 
ideas  and  their  words.  Without  doubt  children  differ  naturally 
in  liveliness  of  disposition ;  but  it  sometimes  happens  that 
depression  reaches  such  a  pass  even  in  very  young  children  as 
to  constitute  a  genuine  melancholia.  In  such  case  the  child 
whines  and  wails  on  all  occasions  ;  whatever  impression  is  made 
upon  it  seems  to  be  followed  by  a  painful  feeling;  the  mother 
takes  it  for  medical  advice,  for,  as  she  complains,  it  thrives  not, 
it  rests  not  either  by  night  or  day,  it  is  pining  and  crying  con- 
tinually, and  nothing  calms  it ;  there  is  no  living  Avith  it,  and 
she  is  almost  worn  out  with  anxiety.  Such  symptoms  mark 
a  constitutional  defect  of  nerve  element,  whereby  an  emotional 
or  sensational  reaction  of  a  painful  kind  follows  all  impressions  ; 
the  nervous  or  psychial  tone  is  radically  infected  with  some  vice 
of  constitution,  so  that  every  natural  impression,  instead  of 
being  pleasing,  is  painful.  The  cause  of  the  defect  in  some 
instances  is  inherited  syphilis ;  at  any  rate  beneficial  results 
follow  the  treatment  for  hereditary  syphilis.     No  doubt,  how- 


278  PATHOLOGY  OF  MIND.  [chap. 

ever,   otlier  causes  besides  syphilis  may  cause  a  like  morbid 
condition  of  nerve  element. 

With  the  deep  melancholic  depression  there  may  be,  in  older 
children,  a  distinct  delusion  of  some  kind.  A  boy  who  from 
his  fifth  year  had  been  rather  peculiar  in  his  behaviour,  standing 
still  at  times  in  the  street  without  apparent  reason  and  not 
moving  again  without  considerable  pressure,  was,  when  twelve 
years  of  age,  afilicted  with  positive  melancholia  and  delusions  of 
suspicion.  He  was  extremely  depressed,  and  his  manner  in- 
dicated the  greatest  fear :  he  was  prone  to  weep  constantly,  and 
was  in  great  dread  of  his  fellow-scholars  and  of  his  teacher,  all 
of  whom,  he  thought,  suspected  him  of  anything  wrong  that 
happened  to  be  done — ^if  a  theft  were  committed,  he  was  sure 
that  he  was  suspected  to  be  the  thief.  He  was  restless  at  night, 
and  often  sighed  and  uttered  unconnected  words  in  his  sleep. 
In  five  weeks  he  was  said  to  have  recovered,  but  there  still 
remained  eccentricities  of  conduct:  if  he  kicked  a  stone,  he 
must  return  to  kick  it  twice  more ;  if  he  spat  once,  he  must 
spit  twice  more  ;  if  he  had  written  a  word  incorrectly,  he  must 
repeat  the  correction.  Of  these  peculiarities  he  was  quite  con- 
scious, and  struggled  against  them,  but  without  avail;  after 
great  restlessness  and  mental  disquietude  he  was  ultimately 
obliged  to  give  way  to  them.^  In  other  like  cases,  morbid 
notions  with  regard  to  religion  may  be  the  exponents  of  the 
emotional  disturbance  of  psychical  tone. 

There  are  boys  who,  being  somewhat  stupid  and  of  a  melan- 
choly, moody,  and  perhaps  morose  disposition,  habitually  keep 
apart  from  their  fellows,  whom  they  join  not  in  play.  They 
are  often  hypochondriacal,  complaining  of  strange  morbid  sen- 
sations in  abdomen,  generative  organs,  heart  or  head  ;  and  when 
these  morbid  feelings  are  very  active  they  become  paroxysm- 
ally  excited  so  as  to  quite  lose  self-control,  and  perhaps  imagine 
that  the  devil  has  got  hold  of  them.  Or  some  other  foolish  or 
insane  idea  or  impulse  springs  up  in  the  apt  soil  of  their  affective 
perversion  and  instigates  them  to  foolish  or  insane  conduct. 
When  they  reach  puberty  they  show  more  insanity,  and  perhaps 
get  into  trouble ;  in  a  stupid  way  they  attempt  to  kill  them- 
^  Irrsein  hei  Kinder,  von  Dr.  Beckham. 


VI.]  THE  IKSANITY  OF  EARLY  LIFE.  279 

selves  or  some  one    else,  or   do    some  other   act   of  criminal 
violence. 

Perhaps  the  most  strildng  form  in  which  the  melancholia 
of   children    manifests  itself   is  by  suicide.      So   strange   and 
unnatural  does  it  seem  that  a  child  of  eight  or  nine  years  of 
age  should,  world-weary,  put  an  end  to  its  own  life,  that  one 
is  apt  to  declare  the  thing  to  be  against  nature  and  to  consider 
it  inexplicable.     Such  act  of  suicide  is  done  sometimes  under 
a  sudden  impulse  from  the  dread  of  punishment  or  after  the 
infliction  of  punishment,  or  it  is  perhaps  deliberately  resolved 
upon  in  a  state  of   sadness  and    depression  consequent  uj)on 
continued  ill  treatment  by  a  brutal  schoolmaster  or   parent.^ 
Falret  mentions   the  case  of  a  boy  of  eleven  years  of  age,  wdio 
was  driven  by  the  ill  treatment  of  his  teacher  into  such  a  state 
of  melancholia  that  he  determined  to  starve  himself,  and  made 
repeated   attempts  at   suicide   by  drowning.      But  it  may  be 
carried  into  effect  out  of  a  constitutional  indifference  or  disgust 
of  life,  or  from  a  momentary  impulse  of  disappointment  when 
there  has  been  no  real  ill  treatment,  nothing  more  perhaps  than 
a  slight  rebuke  or  censure  :    one  boy,  aged  nine  years,  killed 
himself  because  he  lost  a  bird  w^hich  he  was  very  fond  of; 
another  boy,  aged  tw^elve,   hanged  himself  because  he  was  no 
higher  than  twelfth  in  his  class  ;  and  a  boy,  aged  twelve,  hanged 
himself  because  he  was  shut  up  in  a  room  with  a  piece  of  dry 
bread,  as  a  punishment   for   having   accidentally   broken  his 
father's  watch.^     This  premature  disgust  of  life  is    most  often 
the  result  of  some  ancestral  taint,  by  reason  of  which  the  child's 
nervous  constitution  is  inherently  defective,  unapt  to  accom- 
modate itself   to  its   surroundings,   and  disposed  to  perverted 
likings  and  dislikes  and  irregular  reaction.     The  impulse  wliich 
springs  up  out  of  the  deranged  feeling,  and  is  fed  by  it,  is  some- 
times homicidal :  an  instance  occurs  from  time  to  time  in  which 
a  child  drowns,  hangs,  or  otherwise  kills  another  child,  with  an 
amazing  coolness  and  insensibility,  and  from  no  other  motive 
than  a  liking  to  do  it ;  and  there  have  been  a  few  cases  recorded 
in  which  more  than  one  murder  has  been  done  in  this  way  by 


1 


''  Etude  sur  le  Suicide  chez  lesEnfants,"  par  Durand  Fardel— ^mzaZes 
Medico-Psi/chologique,  1855.  -  Durand  Fardel,  op.  at. 

13 


280  PATHOLOGY  OF  MIND.  [chap. 

the  same  cliild.  The  question  of  hereditiiry  taint  is  in  rccahty 
the  important  question  in  those  cases,  as  it  is  in  all  cases  of 
insanity  of  early  life. 

In  the  majority  of  instances  the  affective  insanity  of  early 
life  might  justly  be  described  as  hereditary  ;  but  there  are 
some  cases  in  which  the  morbid  condition  of  nerve  element 
which  manifests  itself  in  extreme  moral  perversion  is  not  in- 
herited, but  acquired  by  reason  of  vicious  habits  of  self-abuse. 
It  is  not  correct,  therefore,  to  describe  all  cases  of  so-called 
moral  insanity  in  children  as  examples  of  hereditary  insanity, 
although  the  precocious  sexual  feeling  which  leads  to  self-abuse 
is  commonly  the  result  of  an  inherited  taint.  I  prefer  using 
the  word  affective  to  the  word  moral,  as  being  a  more  general 
term  and  expressing  more  truly  the  fundamental  condition  of 
nerve-element,  which  shows  itself  in  affections  of  the  mode  of 
feeling  generally,  not  of  the  special  mode  of  moral  feeling  only ; 
in  other  words,  as  pointing  to  that  deepest  affection  of  conscious- 
ness in  its  primordial  elements  which  makes  it  true  to  say  that 
his  affective  life  betrays  the  real  nature  of  the  individual. 

The  examples  of  affective  insanity  in  early  life  fall  naturally 
into  two  divisions :  (<x)  the  first  includes  all  those  instances  in 
which  there  is  a  strange  perversion  of  some  fundamental  instinct, 
or  a  more  strange  appearance  of  some  quite  morbid  impulse ;  (b) 
the  second  division  comprises  all  those  cases  of  complete  moral 
perversion  which  often  seem  to  the  onlooker  to  be  wilful  wicked- 
ness. The  former  might  be  described  as  the  instinctive  or 
impulsive  variety  of  affective  insanity ;  the  latter  as  moral 
insanity  prox^er. 

{a)  Instinctive  Insanity. — "What  are  the  inborn  instincts  of 
mankind  ?  The  instinct  of  self-conservation,  which  is  truly  the 
law  of  the  existence  of  living  matter  as  such,  and  the  instinct 
of  propagation,  which  provides  for  the  continuous  existence  of 
life,  and  is,  therefore,  in  some  sort  a  secondary  manifestation  of 
the  self-conservative  instinct.  The  instinct  to  activity  which  the 
organs  of  relation,  that  is,  the  organs  of  the  so-called  animal 
life,  evince,  and  to  the  particular  sorts  of  activity  which,  being 
adapted  thereto  by  their  form  and  structure,  they  accomplish, 
may  be  looked  upon    as   means  which    the  two  fundamental 


VI.]  THE  INSANITY  OF  EARLY  LIFE.  281 

instincts  make  use  of  in  order  to  attain  tlicir  ends.  Now  tlie 
instinct  of  self-conservation  is  displayed  not  only  by  the  in- 
dividual creature,  whether  of  low  or  high  degree,  but  is  implicit 
in  the  life  of  every  organic  element  of  which  it  is  built :  it  is, 
as  already  seen,  at  the  root  of  the  passions,  which  are  funda- 
mentally determined  by  impressions  according  as  they  are 
pleasing  or  painful  to  self.  Children  are  of  necessity  extremely 
selfish ;  for  it  is  the  instinct  of  their  being  to  appropriate  from 
without,  to  the  end  that  they  may  grow  and  develop :  a  baby  is 
the  only  king,  as  has  been  said,  because  everybody  must  accom- 
modate himself  to  it,  while  it  accommodates  itself  to  nobody. 
The  necessary  correlate  of  the  instinct  of  appropriation  where- 
by what  is  pleasing  to  self  is  assimilated,  is  a  destructive  or 
repulsive  instinct  or  impulse  whereby  what  is  not  grateful  is 
rejected,  got  rid  of,  or  destroyed.  The  infant  rejects  the  mother's 
breast  when  from  some  cause,  internal  or  external,  the  milk  is 
distasteful  to  it ;  by  crying  and  struggling  it  strives  to  get  rid  of 
a  bodily  impression  which  may  happen  to  be  paining  it,  as  the 
Gregarina  shoots  away  from  a  stimulus,  as  the  snail  retracts  its 
protruded  horns  when  they  are  suddenly  touched,  as  a  person 
of  tender  sensibility  shrinks  from  a  painful  spectacle;  and 
when  it  is  a  little  older,  it  rejects,  destroys,  or  attempts  to  destroy 
what  is  not  pleasing  to  it. 

To  talk  about  the  purity  and  innocence  of  a  child's  mind  is 
a  part  of  that  poetical  idealism  and  willing  hypocrisy  by  which 
men  ignore  realities  and  delight  to  walk  in  vain  shows  ;  in  so  far 
as  purity  exists  it  testifies  to  the  absence  of  mind  ;  the  impulses 
which  actually  move  the  child  are  the  selfish  impulses  of  passion. 
It  were  as  warrantable  to  get  enthusiastic  about  the  purity  and 
innocence  of  a  dog's  mind.  "  A  boy,"  says  Plato,  "  is  the  most 
vicious  of  all  wild  beasts"  ;  or,  as  some  one  else  has  put  it,  "  a  boy 
is  better  unborn  than  untaught."  By  nature  sinful  and  vicious, 
man  acquires  a  knowledge  of  good  through  evil :  not  how  evil 
entered  into  him  first,  but  how  good  first  came  out  of  him,  is  the 
true  scientific  question :  his  passions  aie  refined  and  developed 
in  a  thousand  channels  through  wider  considerations  of  interest 
and  foresight  ;  the  history  of  mental  development  begins  with 
the  lowest  passions,  which  flow  as  an  under- current  in  every 


282  PATHOLOGY  OF  MIND.  [chap. 

life,  and  frequently  come  to  the  surface  in  a  very  turbulent  way 
in  many  lives.  Evil  is  good  in  the  making  as  vice  is  virtue  in 
the  making.  1 

In  the  insanity  of  the  young  child  we  meet  with  passion  in  all 
its  naked  deformity  and  in  all  its  exaggerated  exhibition.  The 
instincts,  appetites,  or  passions,  call  them  as  we  may,  manifest 
themselves  in  unblushing,  extreme,  and  perverted  action;  the 
veil  of  any  control  which  discipline  may  have  fashioned  is  rent ; 
it  is  like  the  animal,  and  reveals  its  animal  nature  with  as  little 
shamefacedness  as  the  monkey  indulges  its  passions  in  the  face 
of  all  the  world.  Inasmuch  as  there  is  present  only  the  instinct 
to  gratify  itself,  the  concomitant  of  which  is  the  effort  to  reject 
or  destroy  what  is  not  agreeable,  its  disease,  if  it  become  insane^ 
will  be  exhibited  in  a  perverse  and  unceasing  appropriation  of 
whatever  attracts  its  notice,  and  in  destructive  attacks  upon 
whatever  it  can  destroy.  Eefuse  it  what  it  grasps  at,  and  it  will 
scream,  bite,  and  kick  with  a  frantic  energy  :  give  it  the  object 
which  it  is  striving  for,  and  it  will  smash  it  if  it  can :  it  is  a 
destructive  little  machine  which,  being  out  of  order,  lays  hold  of 
what  is  suitable  and  what  is  unsuitable,  and  subjects  both  alike 
to  its  desperate  action.  Haslam  reports  a  case  of  this  kind  in  a 
girl,  aged  three  and  a  quarter  years,  who  had  become  mad  at  two 
and  a  half  years  of  age,  after  inoculation  for  small-pox.  Her 
mother's  brother  was,  however,  an  idiot,  though  her  parents  were 
sane  and  undiseased.  This  creature  struggled  to  get  hold  of 
everything  which  she  saw,  and  cried,  bit,  and  kicked  if  she  was 
disappointed.  Her  appetite  was  voracious,  and  she  would  devour 
any  sort  of  food  without  discrimination  ;  she  would  rake  out  the 
fire  with  her  fingers,  and  seemed  to  forget  that  she  had  been 


^  "  I  cannot  praise,"  continues  Milton,  after  saying  that  we  know  good 
by  evil,  "  a  fugitive  and  cloistered  virtue,  unexercised  and  unbreathed, 
that  never  sallies  out  and  sees  her  adversary,  but  slinks  out  of  the  race 
where  that  immortal  garland  is  to  be  run  for,  not  without  dust  or  heat. 
Assuredly  we  bring  not  innocence  into  the  world,  we  bring  impurity  much 
rather :  that  which  purifies  us  is  trial,  and  trial  is  by  what  is  contrary.  .  .  . 
That  virtue  therefore  which  is  a  youngling  in  the  contemplation  of  evil, 
and  knows  not  the  utmost  that  Vice  promises  to  her  followers,  and  rejects 
it,  is  but  a  blank  virtue,  not  a  pure  ;  her  whiteness  is  but  an  excremental, 
adventitious  whiteness." 


VI.]  THE  INSANITY  OF  EAKLY  LIFE.  283 

burnt ;  she  passed  her  evacuations  anywhere.  She  could  not  be 
taught  anything,  and  never  improved.^ 

The  most  striking  exhibition  of  the  destructive  impulse  which 
sometimes  reaches  an  extreme  degree  in  the  madness  of  child- 
hood is  afforded  by  a  homicidal  tendency.  "  A  girl,  aged  five 
years,  conceived  a  violent  dislike  to  her  stepmother,  who  liad 
always  treated  her  kindly,  and  to  her  little  brother,  both  of  whom 
she  repeatedly  attempted  to  kill."  ^  Here  was  a  sort  of  conscious 
design  apparent  in  the  act ;  but  it  is  obvious  that  the  further 
back  in  mental  development  we  go,  the  less  of  conscious  design 
will  there  be  in  the  morbid  impulse.  Moreover,  in  the  case  of 
homicidal  impulse  in  a  young  child,  the  consciousness  of  the  end 
or  aim  of  the  act  must  at  best  be  very  vague  and  imperfect :  it 
is  driven  by  an  impulse  of  which  it  can  give  no  account  to  a 
destructive  act,  the  real  nature  of  which  it  does  not  appreciate ; 
a  natural  instinct  being  exaggerated  and  perverted  by  disorder  of 
the  nerve-centre.  It  matters  not  much,  so  far  as  its  nature  is 
concerned,  what  is  the  particular  form  of  the  destructive  impulse 
— whether  it  be  homicidal  or  suicidal,  or  to  set  fire  to  the  house, 
or  to  kill  a  cat  or  a  canary,  or  to  smash  crockery  or  other  perish- 
able ware;  the  impulse  which  dominates  it  is  as  unreasoning 
and  apparently  uncontrollable  as  the  convulsion  of  its  limb  is 
in  chorea.  Many  cases  are  on  record  of  older  children  who  have 
displayed  an  incorrigible  propensity  to  acts  of  pure  cruelty  and 
destruction,  practised  on  such  creatures  as  were  not  too  powerful 
to  be  their  victims. 

Thus  much  concerning  those  phenomena  of  insanity  in  childi-en 
which  spring  from  the  gross  perversion  of  the  self-conservative 
impulse.  Let  me  now  say  a  few  words  concerning  the  perversion 
of  the  instinct  of  propagation.  It  is  necessary  to  guard  against 
a  possible  objection  that  this  instinct  is  not  felt  until  puberty. 
There  are  certainly  frequent  manifestations  of  its  existence 
throughout  early  life,  both  in  animals  and  in  children,  before 
there  is  a  consciousness  of  the  aim  or  design  of  the  blind  im- 
pulse. Whosoever  avers  otherwise  must  have  paid  very  little 
attention  to  the  gambols  of  young  animals,  and  must  be  strangely 

^  Observations  on  Marlnesi^. 

2  Esquirol,  Traite  des  Maladies  Mentales. 


284  PATHOLOGY  OF  MIND.  [chap 

or  hypocritically  oblivious  of  the  events  of  his  own  early  life. 
At  puberty  the  instinct  makes  its  appearance  in  consciousness, 
and  thereupon  attains  to  knowledge  of  its  aim  and  craves  means 
of  gratification  ;  in  like  manner  as,  in  the  course  of  development 
through  the  ages,  the  blind  procreative  instinct  which  is  im- 
manent in  animal  nature  undergoes  a  marvellous  evolution 
within  human  consciousness,  blossomimr  into  all  the  glories  of 
human  love. 

As  there  are  exhibitions  of  this  blind  impulse  in  the  healthy 
child,  it  is  not  surprising  to  meet  with  exaggerated  and  per- 
verted manifestations  of  it  in  the  insane  child.  The  enthu- 
siastic idealist,  greatly  shocked  by  disgusting  exhibitions  of 
unnatural  precocity  in  children  of  three  or  four  years  of  age, 
exclaims  against  them  as  if  they  were  unaccountable  and 
monstrous ;  but  they  are  not  without  interest  to  the  scientific 
observer,  who  sees  in  them  valuable  instances  on  which  to  base 
his  generalisations  concerning  man,  not  as  an  ideal  but  as  a  real 
being,  and  concerning  his  origin,  not  as  a  special  creation,  but 
as  the  supreme  product  of  natural  evolution.  In  the  Philo- 
sophical Transactions  for  1745  is  the  account  of  a  boy,  aged  only 
two  years  and  eleven  months,  who  displayed  a  remarkable 
sexual  precocity.  Esquirol  quotes  the  case  of  a  girl,  aged  three 
years,  who  was  constantly  putting  herself  into  the  most  indecent 
attitudes,  and  used  to  practise  the  most  lascivious  movements 
against  any  convenient  piece  of  furniture.  At  first  the  parents 
thought  nothing  particular  of  it,  but  finding  the  practice  con- 
tinued, and  of  unmistakable  significance,  they  tried  every 
means  in  their  powder  to  check  it,  but  without  avail.  In  church 
or  anywhere,  at  the  sight  of  an  agreeable  object,  there  was  the 
same  abandonment,  ending  in  a  general  spasm.  The  child  con- 
fessed to  a  positive  pleasure  from  the  acts,  continued  them  as 
she  grew  uj),  and,  though  ultimately  married,  was  a  regular 
nymphomaniac.  The  greatest  salacity  was  always  manifested 
from  the  beginning  to  the  end  of  spring.^  Other  similar 
examples  of  this  sort  of  instinctive  insanity  might  easily  be 
adduced  :  for  there  are  few  physicians  in  practice  who  could  not 
relate  instances  of  young  children  of  three  or  four  years  of  age 

^  See  also  Morel's  Etudes  CUniques  sur  les  Maladies  Mcnfales,     1852. 


VI.]  THE  INSANITY  OF  EARLY  LIFE.  285 

who  have  perplexed  and  distressed  their  parents  by  the  preco- 
cious display  of  active  sexual  tendencies.  The  afllicted  creature 
has  no  definite  consciousness  of  the  import  of  its  precocious 
acts ;  certain  attitudes  and  movements  are  the  natural  gesture- 
language  of  certain  internal  states — their  motor  exponents ;  and 
it  is  little  more  than  an  organic  machine  automatically  impelled 
by  disordered  nerve-centres. 

(h)  Moral  Insanity. — This  variety  of  affective  insanity  might 
be  illustrated  by  numerous  examples  of  all  degrees  of  severity, 
rano-in^j  from  what  miq:ht,  not  without  reason,  be  described  as 
simple  viciousness  to  those  extremer  manifestations  which  pass 
far  beyond  the  bounds  of  what  any  one  would  call  vice.  In  the 
spring  of  1827,  Dr.  Prichard  w^as  asked  to  see  the  daughter  of  a 
farmer,  in  some  members  of  whose  family  insanity  existed.  She 
w^as  a  little  girl,  aged  seven,  and  was  described  as  having  been 
quick  at  apprehension,  lively,  affectionate,  and  intelligent.  A 
great  change,  however,  took  place  in  her  conduct :  she  became 
rude,  vulgar,  abrupt,  and  perfectly  unmanageable ;  doing  no 
"work,  running  about  the  fields,  and,  if  rebuked,  very  abusive 
and  extremely  passionate.  Her  appetite  was  perverted  so  that 
she  preferred  raw  vegetables  to  her  proper  food ;  and  she  would 
sleep  on  the  cold  and  wet  ground  rather  than  upon  her  bed. 
Her  parents  had  no  control  over  her,  and  she  was  persistently 
cruel  to  her  sisters,  pinching  them  when  she  could  do  so  without 
being  observed.  She  had  a  complete  knowledge  of  persons  and 
things,  and  recollected  all  that  she  had  learned.  Her  eyes 
glistened  brilliantly;  the  conjunctiva  was  reddened;  her  head 
was  hot,  her  extremities  w^ere  cold,  and  her  bowels  disordered ; 
thei-e  was  a  disagreeable  odour  of  the  body.  Dr.  Prichard  saw 
her  in  the  house  of  a  medical  man  where  she  had  been  placed 
because  she  was  getting  w^orse  at  home.  "  At  this  time  she  had 
taken  to  eat  her  own  faeces,  and  to  drink  her  urine,  and  she 
'would  swear  like  a  fishwoman  and  destroy  everything  within 
her  reach ;  yet  she  was  fully  conscious  of  everything  she  did, 
and  generally  appeared  to  know  w^ell  that  she  had  done  wrong." 
After  doing  something  wrong  she  would  exclaim,  ''Well,  Mrs. 
H.,  I  have  done  it.  I  know  you  will  be  angry ;  but  I  can't  help 
it,  and  I  could  not  let  it  alone  until  I  had."     Among  her  plea- 


286  PATHOLOGY  OF  MIND.  [chap. 

sures  was  that  of  dirtying  herself  as  frequently  as  she  had  clean 
clothes  put  on ;  indeed,  "  she  would  rarely  pass  her  excrements 
into  the  proper  place,  but  reserved  them  for  the  carpet  of  the 
sitting-room,  or  for  her  own  clean  clothes."  "At  other  times 
she  was  so  far  conscious  of  her  situation  as  to  cry  bitterly,  and 
express  her  fears  that  she  would  become  like  her  aunt,  who  was 
a  maniac.  In  addition  to  all  these  indications  she  had  stolen 
everything  which  she  thought  would  be  cared  for,  and  either 
hid  or  destroyed  it ;  and  swore  in  language  which  it  is  difficult 
to  imagine  that  such  a  child  could  ever  have  heard."  There 
was  no  fixed  idea  which  influenced  her  conduct ;  she  acted 
"from  the  impulse  of  her  feelings,  and  these  were  unnatural, 
and  perverted  by  disease."     After  two  months  she  recovered.^ 

Haslam  relates  the  following  case  of  a  young  gentleman,  aged 
ten,  in  whose  ancestors  no  insanity  was  acknowledged.  When 
only  two  years  old,  he  was  so  mischievous  and  imcontrollable 
that  he  was  sent  from  home ;  and  until  he  was  nine  years  old 
he  continued  *'the  creature  of  volition  and  the  terror  of  the 
family,"  and  was  indulged  in  every  way :  he  tore  his  clothes, 
broke  whatever  he  could  break,  and  often  would  not  take  his 
food.  Severe  discipline  was  tried,  but  in  vain ;  and  the  boy 
was  ultimately  sent  to  a  lunatic  asylum.  There  was  deficient 
sensibility  of  the  skin.  He  had  a  very  retentive  memory  with 
regard  to  matters  which  he  had  witnessed,  but  was  attracted 
only  by  fits  and  starts,  so  that  he  would  not  learn  methodically : 
he  was  "  the  hopeless  pupil  of  many  masters,"  breaking  windows, 
crockery,  and  anything  else  which  he  could  break.  A  cruel 
trick  of  his  was,  whenever  the  cat  came  near  him,  to  seize  it, 
j)luck  out  its  whiskers  with  wonderful  skill  and  rapidity,  saying, 
*'  I  must  have  her  beard  off,"  and  then  commonly  to  throw  it  on 
to  the  fire  or  through  the  window.  He  was  quite  insensible  to 
kindness,  and  never  played  with  other  boys.  "  Of  his  own 
disorder  he  was  sometimes  sensible :  he  would  often  express 
a  wish  to  die,  for  he  said  very  truly,  *  God  had  not  made  him 
like  other  children ;  *  and  when  provoked  he  would  threaten  to 
destroy  himself."     No  improvement  took  place. 

1  On  the  Different  Forms  of  Insanity  in  relation  to  Jurispnidence.  By 
J.  C.  Pritchard,  M.D.,  1842. 


VI.]  THE  INSANITY  OF  EARLY  LIFE.  287 

A  case  in  some  respects  similar  is  quoted  by  Moreau  from 
Kenaudin,  under  whose  care  it  was : — A  boy,  whose  intelligence 
and  behaviour  were  usually  of  an  ordinary  character,  was  subject 
every  now  and  then  to  a  positive  mania  of  acts,  without  any 
mental  incoherence.^  When  these  attacks  came  on  him  he  was 
quite  incorrigible,  and  he  had  been  expelled  from  different 
schools  in  consequence  of  them.  After  several  unsuccessful 
trials  at  discipline,  he  was  at  last  sent  to  an  asylum.  There  he 
answered  quite  intelligently,  but  wept  and  was  silent  when 
vspoken  to  about  his  bad  conduct:  pressed  upon  this  subject,  he 
said  that  he  could  not  help  it.  The  interesting  circumstance 
was  that  there  was  a  complete  insensibility  of  the  skin  at  the 
time  of  the  attacks  of  irresistible  violence,  and  that  in  his  docile 
and  affectionate  intervals  the  sensibility  of  the  skin  was  natural. 
The  acts  of  violence  were  of  so  extreme  a  character  that,  says 
the  reporter,  "  we  were  able  to  satisfy  ourselves  that  they  might 
go  as  far  as  murder."  ^ 

The  special  defective  sensibility  of  skin  in  these  cases  is  full 
of  instruction  in  relation  to  the  profound  and  general  defect  or 
perversion  of  the  sensibility  or  receptive  capacity  of  the  whole 
nervous  system  wliich  is  shown  in  their  perverted  likings  and 
dislikes,  in  their  inability  to  join  with  other  children  in  play  or 
work,  and  in  the  impossibility  to  modify  their  characters  by 
discipline ;  they  cannot  feel  impressions  as  they  naturally  should 
feel  them,  nor  adjust  themselves  to  their  surroundings,  with 
which  they  are  in  discord;  and  the  motor  outcomes  of  the 
perverted  affections  of  self  are  accordingly  of  a  meaningless 
and  destructive  character.  The  insensibility  of  skin  is  the  out- 
ward and  visible  sign  of  a  corresponding  inward  and  invisible 
defect,  as  it  notably  is  also  in  idiocy. 

These  examples  may  suffice  to  illustrate  a  form  of  derange- 
ment which  undoubtedly  occurs  in  early  life,  and  which, 
indeed,  is  more  readily  acknowledged  when  it  is  met  with  in 
young  children  than  when  it  is  met  with  in  the  adult,  in 
whom  it  is  more  apt  to  be  thought  vice.  The  extreme  acts  of 
precocious  wickedness  seem  so  inconsistent  with  the  immaturity 

1  Moreau's  Psychologie  Morhide,  p.  313. 

2  I  have  related  a  case  of  moral  insanity  in  a  young  girl  in  ray  work 
On  Responsibility  in  Mental  Disease,  p.  180,  third  edilion. 


288  PATHOLOGY  OF  MIND.  [chap. 

of  cliildliood  that  they  are  readily  accounted  unnatural,  and 
ascribed  to  disease.  However,  to  call  them  disease  is  not  to 
explain  them,  nor  to  cancel  the  need  of  an  explanation.  Who- 
soever scrupulously  traces  the  acts  as  the  necessary  consequences 
of  certain  coefficient  causes  implied  in  tlie  vitiated  constitution 
of  the  nerve  element  of  the  child,  and  thus  banishes,  as  he  must 
do,  the  notion  of  witting  and  wilful  vice,  will  be  brought  to  own 
in  theory,  as  he  will  discover  in  practice,  that  like  physical 
conditions  in  the  adult  may  be  the  agents  in  producing  like 
morbid  effects. 

There  are  children  of  a  defective  mental  capacity,  not  reaching 
tlie  degree  of  idiocy,  or  even  of  positive  imbecility,  wdiom  it  is 
very  difficult  to  know  what  to  do  with  sometimes.     They  are 
dull,  heavy,  stupid,  appear  indolent,  indifferent,  and  as  if  they 
will  not  try  to  learn  anything,  and  display  low  or  vicious  tastes ; 
when  sent  to  a  respectable  school,  they  are  commonly  after  some 
time  sent  home  again  as  impracticable.     Their  inability  to  learn 
looks  very  much  like  stupidity  and  obstinacy,  when  it  is  really 
the  result  of  disease,  and  marks  a  certain  measure  of  imbecility. 
Their  nervous  centres  are  ill  fitted,  by  reason  of  some  defect  of 
constitution  or  of  some  gross  morbid  condition,  to  receive  and  to 
retain  impressions ;  they  lack,  therefore,  the  disposition  or  desire 
and  the  aptitude  which  are  natural  in  a  sound  bodily  state  to 
get  into  closer  relations  with  the  objects  producing  them ;  and 
the  motor  reactions  are  not  purposely  made  to  repeat  and  to 
vary  the  impressions  until  the  objective  causes  of  them   are 
thoroughly  apprehended.      It  is  sometimes  the  misfortune  of 
boys  of  this  sort  to  be  sent,  after  failing  at  the  usual  schools,  to 
some  one  who  advertises  for  unruly  pupils,  and  who  represents 
himself  as  possessed  of  some  specific  for  managing  and  trainhig 
them.     Some  years  since  a  boy  of  this  kind  was  said  to  have 
been  flogged  to  death  by  his  master,  wdio  was  put  upon  his  trial 
for  manslaughter,  found  guilty,  and  received  a  severe  sentence. 
Without  doubt  the  poor  boy  was  harshly  and  cruelly  used,  but 
there  were  some  medical  reasons  for  thinking  that  the  case  was 
not  quite  so  bad  as  it  was  represented  in  the  public  papers  at 
the  time.    In  some  of  these  cases  of  semi-imbecility  or  stupidity 
there  is  an  abnormal  quantity  of  serum  in  the  ventricles  of  the 


V1.J  THE  INSANITY  OF  EARLY  LIFE.  28U 

brain,  and  death  may  take  place  suddenly  in  consequence  of 
the  increase  of  the  fluid  beyond  a  certain  amount.  In  the  case 
referred  to  an  unusual  quantity  of  serum  was  found  in  the 
ventricles  of  the  brain  after  death ;  and  the  medical  man  who 
was  called  for  the  prosecution  gave  it  as  his  opinion  that  this 
was  the  result  of  the  ill  treatment  to  which  the  boy  had  been 
subjected,  and  the  probable  cause  of  death.  In  reality,  the 
morbid  condition  of  things  may  have  been  the  cause  of  the 
youth's  stupidity,  and  so  his  death  have  been  occasioned  by  a 
punishment  which  would  not  have  seriously  injured  a  healthy 
child.  When  we  reflect  on  the  possible  state  of  things  in  the 
brain,  it  will  be  obvious  that  no  good,  but  much  mischief,  will 
be  done  by  harsh  measures :  patience  and  gentleness,  kindness 
and  encouragement,  good  diet  and  regular  habits,  proper  bodily 
exercise,  and  the  regular  control  of  some  judicious  person,  will 
be  the  best  means  to  employ.  Above  all  things,  it  is  well  to 
forego  attempts  to  make  such  defectively  organised  beings  reach 
a  degree  of  mental  development  which  they  are  by  nature 
incapable  of ;  they  should  be  put  to  some  humble  occupation 
for  which  they  are  fitted,  and  in  which  they  may  succeed 
fairly. 

There  is  another  class  of  boys  who  cause  great  trouble  and 
anxiety  to  their  parents  and  to  all  persons  who  have  to  do  with 
them.  Afflicted  with  a  positive  moral  imbecility,  they  are 
inherently  vicious;  they  are  instinctive  liars  and  thieves, 
stealing  and  deceiving  with  a  cunning  an-d  a  skill  which  could 
never  be  acquired;  they  have  no  trace  of  affection  for  their 
parents  or  of  good  feeling  for  others ;  the  only  care  which  they 
have  is  to  contrive  means  to  indulge  their  passions  and  vicious 
propensities,  and  this  they  will  do  with  singular  iugenuity  and 
acuteness.  Intellectually  some  of  them  are  defective  also,  for 
they  read  no  better  when  they  are  sixteen  years  old  than  a 
healthy  child  of  six  years  of  age  would  do ;  and  yet  these  are 
very  cunning  in  deception  and  in  gratifying  the  desires  of  their 
vicious  natures.  Others  show  no  evident  defect  of  intelliirence : 
their  general  education  may  be  fairly  good,  and  some  of  them 
shall  display  extraordinary  cleverness  of  a  particular  kind  ; 
the  surprising  thing  being  that,  having  so  acute  an  intelligence, 


290  PATHOLOGY  OF  MIND.  [chap. 

they  sliould  be  so  utterly  incapable  as  tliey  are  of  seeing  how 
much  their  conduct  is  against  their  true  interest.  However,  so 
it  is :  their  self-feeling  is  so  intense  and  engrossing,  that  they 
cannot  look  beyond  the  present  gratification,  and  their  intellect 
is  enlisted  entirely  in  its  service.  Oftentimes  they  are  exceed- 
ingly plausible,  having  a  good  address,  impose  skilfully  upon 
people  whom  they  meet,  and  get  out  of  scrapes  in  an  extraordi- 
I  narily  clever  way.  When  they  are  in  trouble  they  express 
'  the  most  bitter  regret,  write  the  most  penitent  letters,  make  the 
most  solemn  promises  of  amendment,  without  the  least  sincerity, 
or  at  any  rate  without  making  the  least  effort  to  do  right  on  the 
next  occasion  when  temptation  comes.  In  one  case  a  boy,  who 
was  not  fourteen  years  old  when  I  saw  him,  had  been  a  trouble 
to  his  parents  for  years :  he  was  most  cunning  and  ingenious  in 
lying,  showing  a  marvellous  precocity  therein,  and  a  persistent 
passion  for  it ;  used  to  abandon  himself  to  paroxysms  of  violent 
passion,  and  threaten  or  pretend  to  commit  suicide  ;  was  acute 
enough  as  regarded  his  personal  interests,  but  could  not  learn 
like  other  boys,  nor  did  he  associate  with  them;  evinced  no 
trace  of  moral  element  nor  of  social  sympathy.  He  would 
stand  for  an  hour  at  a  time  before  a  map  of  the  world  while 
other  boys  were  at  play,  and  could  tell  every  place  upon  it  where 
a  ship  must  call ;  he  could  also  tell  every  train  in  Bradshaw's 
Eailway  Guide  on  the  Midland  line.  Another  boy,  who  was  the 
son  of  a  gentleman  of  high  social  position,  and  had  at  command 
everything  a  boy  could  wish  for,  could  not  be  prevented  from 
stealing  wherever  he  went. 

After  puberty  matters  usually  get  worse  in  these  cases :  they 
give  themselves  up  to  intemperance,  licentiousness,  self-abuse,  or 
are  guilty  of  stealing,  of  forgery,  of  unnatural  offences,  and  of 
other  vices  or  actual  crimes.  If  they  are  females,  they  abandon 
tliemselves  to  sexual  indulgence ;  or  if  they  are  prevented  from 
that  by  the  restraints  of  their  position  in  life,  they  may  make 
gross  charges  of  immorality  against  innocent  persons,  perhaps 
writing  the  filthiest  anonymous  letters.  In  a  perverse  mood  they 
may  set  fire  to  the  house,  or  kill  their  employer's  child,  if  they  are 
in  service,  rather  than  have  the  trouble  to  look  after  it.  They  are 
truly  bedevilled.     When  these  degenerate  beings  belong  to  the 


VI.]  THE  INSANITY  OF  EARLY  LIFE.  291 

lower  classes,  they  find  their  way  to  prison  many  times — indeed, 
they  go  to  swell  the  criminal  population  of  the  country ;  when 
they  belong  to  the  better  classes  they  are  an  infinite  trouble,  and 
in  order  to  keep  them  out  of  prison  there  is  nothing  for  it  but  to 
seek  out  some  firm  and  judicious  person  who,  for  suitable  remu- 
neration, will  take  care  of  them,  keep  them  out  of  mischief,  and, 
while  checking  their  vicious  propensities,  try  to  discover  and 
foster  any  better  tendencies  which  they  may  have  in  them. 

In  all  cases  of  affective  insanity,  and  especially  of  that  variety 
which  I  have  described  as  moral  insanity,  the  question  of  ques- 
tions is  hereditary  taint.  As  the  nature  of  man  has  grown 
slowly  to  what  it  now  is  by  a  progressive  fashioning  through 
generations,  so  by  a  retrogressive  degeneration  it  passes  back- 
wards to  a  lower  stage ;  the  stage  to  which  it  sinks  being  worse 
than  a  corresponding  stage  of  deficient  development,  because 
while  the  latter  marks  an  absence  of,  it  is  a  corruption  of, 
the  higher.  The  progress  of  organic  development  through  the 
ages  is  a  progressive  internal  specialisation  in  relation  to  external 
nature;  the  human  organism,  as  the  highest  organic  develop- 
ment, has  the  most  special  and  complex  relations  with  the 
external ;  and  the  highest  mental  development,  as  the  supreme 
development  of  the  human  organism,  represents  the  completest 
expression  of  the  most  special  and  complex  harmony  between 
man  and  nature.  Xow  this  concord  will  plainly  be  destroyed, 
and  a  discord  produced  instead,  by  that  inherent  defect  of  nerve 
element  which  an  hereditary  taint  implies  ;  for  it  implies,  as  we 
have  seen,  a  predisposition  to  discordant  action.  Accordingly, 
there  is  witnessed  in  the  infant,  long  before  any  responsibiKty 
attaches  to  its  acts,  either  a  congenital  inability  to  respond  to 
external  impressions,  whereby  idiocy  of  greater  or  less  degree  is 
the  consequence,  or  a  defective  nervous  constitution,  whereby 
the  natural  assimilation  of  impressions  and  the  fitting  reaction 
to  them  are  seriously  interfered  with.  In  the  worst  cases  there 
w^ould  seem  to  be  a  positive  defect  in  the  composition  or  consti- 
tution of  nervous  element;  its  fundamental  self-conservative 
impulse,  as  living  matter  of  specific  quality,  to  be  abolished. 
The  strange  perversions  of  the  child's  appetites  and  instinctive 
strivings  evince  this;   instead  of  displaying  an  aversion  from 


292  PATHOLOGY  OF  MIND.  [chap. 

what  is  injurious  and  rejecting  it,  the  young  creature  positively 
seizes  with  eager  appetite  what  is  most  baneful. 

lu  all  degrees  and  kinds  of  healthy  life  we  witness  in  opera- 
tion the  attraction  of  what  is  suitable  to  growth  and  development 
and  the  repulsion  of  what  is  unsuitable :  in  the  lowest  forms  of 
life  we  describe  them  simj)ly  as  attraction  and  repulsion,  or 
assimilation  and  rejection  ;  as  we  rise  higher  in  the  scale  of  life 
the  attraction  becomes  appetite  and  the  repulsion  becomes  aver- 
sion ;  higher  still  the  attraction  is  desire  or  love,  the  repulsion  is 
dislike  or  hate,  although  if  there  is  any  character  of  uncertainty 
about  the  event,  hope  and  fear  are  used  to  express  the  opposite 
tendencies;  and  the  last  and  highest  development  of  them  is 
willingness  and  umvillingness.  But  in  the  child  which  is  born  with 
so  strong  a  predisposition  to  insanity  that  it  cannot  develop,  there 
is  an  absence  of  this  pre-established  harmony  between  the  in- 
dividual constitution  and  external  nature :  the  morbid  creature 
devours  with  eager  appetite  the  greatest  trash,  and  rakes  out  the 
fire  with  its  fingers ;  it  desires  passionately  and  struggles  franti- 
cally for  what  is  detrimental  to  it,  and  rejects  or  destroys  what 
is  suitable  and  should,  were  it  rightly  constituted,  be  agreeable ; 
it  loves  nothing  but  destructive  and  vicious  acts,  which  are  the 
expressions  of  an  advanced  degradation,  and  hates  that  which 
would  further  its  development  and  is  necessary  to  its  existence 
as  a  social  being.  As  it  grows  older,  perversities  of  social  feel- 
ing and  conduct  mark  its  discordant  bias.  By  reason  of  its 
physical  constitution  it  is  a  fundamental  discord  in  nature;  and 
its  perverse  desires  and  doings  are  the  outcome  of  a  gradually 
proceeding  course  of  deterioration  whereby  it  ultimately  goes  to 
destruction.  It  cannot  assimilate  nature,  and  nature  wdll  there- 
fore, sooner  or  later,  assimilate  it.  Meanwhile,  as  a  diseased 
element  in  the  social  organism,  it  must  be  isolated  or  removed 
for  the  good  of  the  organism. 

As  the  mad  acts  of  the  insane  child  mark  a  degenerate  state 
of  nerve  element,  so  it  represents  a  degenerate  variety  or  morhid 
kind  of  human  being.  However  low  such  a  being  may  be 
brought  he  never  reverts  to  the  exact  type  of  any  animal ;  the 
fallen  majesty  of  mankind  appearing  even  in  the  worst  wrecks. 
There  is  sometimes  a  general  resemblance  to  one  of  the  lower 


VI.]  THE  INSANITY  OF  EAKLY  LIFE.  293 

animals,  but  the  resemblance  is  no  more  than  a  general  and  super- 
ficial one  ;  all  the  special  differences  of  mental  qualities  are  more 
or  less  manifest  just  as  all  the  special  differences  of  anatomical 
structure  remain.  The  idiot,  with  hairy  back,  may  go  on  his  knees 
and  "  bah  "  like  a  sheep,  as  did  one  of  which  Pinel  tells ;  but  as 
he  does  not  get  the  wool  and  conformation  of  the  sheep,  so  he  does 
not  get  its  psychical  characters  :  he  is  not  adapted  to  the  relations 
of  the  sheep,  and  if  placed  in  them,  would  surely  perish,  and  he 
does  evince  traces  of  adaptation  to  his  relations  as  a  human  being 
which  the  best  developed  animal  never  would.  So  also  with 
regard  to  man's  next  of  kin,  the  monkeys  :  no  possible  arrest  of 
development,  no  degradation  of  human  nature  through  genera- 
tions, will  bring  him  to  the  special  type  of  the  monkey :  a 
degenerate  kind  of  human  being  is  produced,  but  it  is  a  morhid 
kind,  wanting  the  instincts  of  the  lower  animals,  and  the  uncon- 
scious upward  aspirations  of  their  nature,  as  well  as  the  reason 
of  man  and  his  conscious  aspirations.  It  is  a  very  rare  thing, 
for  example,  to  meet  among  idiots  with  that  instinctive  discri- 
mination of  poisonous  matters  which,  some  beasts  have ;  on  the 
other  hand,  it  is  very  common  to  meet  among  them  with  a  per- 
verted craving  for  improper  food  or  injurious  substances,  which 
is  in  reality  the  unconscious  display  of  nature's  effort  to  extin- 
guish a  morbid  variety,  and  which,  but  for  charitable  interference 
and  fostering  care,  would  soon  accomplish  its  aim. 

Man  exists  in  an  intimate  correlation  with  nature  at  its  pre- 
sent stage  of  development — is,  as  it  were,  the  outgrowth  at  this 
stage  of  its  evolution,  and  therefore  flourishes  well  under  existing 
conditions  :  the  monkey,  on  the  other  hand,  is  not  in  harmony 
with  the  complexity  of  surrounding  nature,  modified  as  this  has 
been  so  mightily  by  man,  and  is  rapidly  becoming  extinct,  the 
stronger  species  surely  superseding  it.  "Were  it  desired  to  bring 
man  to  the  monkey  level,  it  would  be  necessary  to  undo  the 
latest  mighty  changes  in  nature,  and  to  restore  the  condition  of 
things  which  prevailed  ages  before  he  appeared,  and  of  which 
the  monkey  was  the  natural  outgrowth.  While,  then,  the  monkey 
type,  and  every  other  pure  animal  type,  represent  stages  in  the  up- 
ward development  of  nature,  the  theraid  degenerations  of  man- 
kind are  pathological  specimens,  which,  not  being  serviceable. 


294  PATHOLOGY  OF  MIND.  [chap. 

for  development,  are  cast  off  by  the  stream  of  progress,  and 
are  on  their  way  to  destruction,  for  re-issne  by  nature  under 
better  form.  By  such  examples  of  dehumanisation  men  are 
taught  how  best  to  promote  the  progress  of  humanisation  through 
the  aG;es. 

The  foregoing  considerations  help  us  to  understand  how  it  is 
that  we  sometimes  witness  such  a  precocity  of  seeming  vice  in 
the  insane  infant  or  child.  Innate  in  its  human  constitution 
lurks  the  potentiality  of  a  certain  development,  the  latent  power 
of  an  actual  evolution  which  no  monkey  ever  has ;  for  in  it  is 
contained,  as  by  involution,  or  implicitly  comprehended,  the  in- 
fluence of  all  mankind  that  has  gone  before.  When  such  a  being 
is  insane,  there  is  not  an  individual  creature  only,  but  there  is 
human  nature,  in  perverse  action,  in  retrograde  metamorphosis ; 
we  have  actualised  in  morbid  display  certain  potentialities  of 
humanity ;  accordingly  exhibitions  of  degenerate  human  action 
are  presented,  which  so  far  as  regards  the  individual  infant 
seem  to  mark  prematurity  of  vice.  Humanity  is  contained  in 
the  individual;  and  in  these  strange  morbid  displays  there  is 
an  example  of  humanity  undergoing  resolution.  Whatever  act 
of  vice,  of  folly,  of  crime,  of  madness  one  man  has  perpetrated, 
there  is  in  every  man  the  potentiality  of  perpetrating  ;  if  it  were 
not  so,  why  repeat  the  decalogue  ?  In  the  sense  of  anything  in 
nature  being  self-determined  and  self-sufficing,  there  is  no  indi- 
viduality :  as  in  one  word  are  summed  up  the  foregoing  ages  of 
liuman  cultivation,  so  in  one  mortal  are  summed  up  the  foregoing 
ages  of  human  existence.  Both  in  his  knowledge  and  in  his 
nature  each  one  is  the  inheritor  of  the  acquisitions  of  the  past — 
the  heir  of  all  the  ages.  Take  the  word  which  represents  the* 
subtile  and,  as  it  were,  petrified  thought  of  a  high  mental  culture, 
and  trace  back  with  analytical  industry  its  genesis, — resolve  it 
into  its  elementary  production, — what  a  long  succession  of  human 
experiences  is  unfolded  !  What  a  gradual  process  of  growth, 
rising  in  speciality  and  complexity  up  to  that  organic  evolution 
which  the  word  now  marks,  is  displayed  !  Take,  in  like  manner, 
the  individual  being,  and  trace  back  in  imagination  through  the 
long  records  of  ages  the  antecedent  steps  of  his  genesis,  or  observe 
intelligently  the  resolution  of  his  essential  human  nature  as  it 


VI.]  THE  INSANITY  OF  EARLY  LIFE.  295 

is  exhibited  in  the  degenerate  acts  of  tlie  insane  child — in  this 
experiment  thus  obtruded  on  the  attention  by  nature — and  there 
will  then  be  no  cause  for  surprise  at  phenomena  which  the  young 
creature  could  never  have  individually  acquired,  and  which,  so 
far  as  its  conscious  life  is  concerned,  appear  strangely  precocious 
and  inexplicable.  There  is  the  rapid  undoing  of  what  has  been 
slowly  done  through  the  ages  ;  the  disruption  and  degenerate 
manifestation  of  faculties  which  have  been  tediously  acquired ; 
the  resolution  of  what  has  been  the  gain  of  a  long  process  of 
evolution ;  the  formless  ruin  of  carefully  fashioned  form.  "We 
are  sad  witnesses  of  the  operation  of  a  pathological  law  of 
dehumanisation  in  producing  dehumanised  varieties  of  the 
human  kind. 


CHAPTER  VII. 

THE   SYMPTOMATOLOGY   OF   INSANITY. 

Much  discussion,  into  wliich  I  shall  not  enter  here,  has  taken 
place  at  different  times  concerning  the  proper  method  of  classify- 
ing the  varieties  of  mental  derangement,  and  as  many  as  forty 
or  fifty  different  systems  of  classification  have  been  propounded: 
a  sufficient  proof  that  no  one  has  yet  been  found  to  be  satis- 
factory. Some  writers  desire  to  have  an  exact  pathological 
basis  for  each  of  the  varieties  which  they  recognise,  and  throw 
scorn  on  anything  short  of  that,  before  they  have  done  more 
than  cross  the  pathological  threshold,  and  while  they  still 
know  nothing  of  what  is  going  on  in  the  intimate  and  inac- 
cessible workings  of  nerve  element.  Doubtless,  their  day  will 
come  a  long  time  hence ;  in  the  meantime  we  may  pass  them 
by  as  persons  whose  eager  aspirations  have  outrun  practical 
needs,  and  whose  enthusiasm  oftentimes  forestalls  observation. 
The  commonly  received  classification  is  the  least  ambitious, 
since  it  is  founded  upon  the  recognition  of  the  obvious  differ- 
ences of  the  mental  features — that  is  to  say,  is  entirely  sympto- 
matological;  it  is  simply  a  convenient  scheme  for  grouping 
together  into  some  sort  of  provisional  order  phenomena  which 
resemble  one  another,  without  regard  to  their  real  nature,  their 
origin,  and  their  essential  relations,  concerning  all  which  it  gives 
no  information.  We  group  together  under  the  name  of  Melan- 
cholia a  number  of  cases  in  which  the  symptoms  are  those  of 
great  depression,  and  under  the  name  of  Mania  other  cases  in 
which  the  symptoms  are  those  of  exaltation  and  excitement, 
notwithstanding  that  what  seems  to  be  tlie  same  cause  may 
produce  the  depressed  form  in  one  person  and  the  excited  form 


CH.  TIL]  THE  SYMPTOMATOLOGY  OF  INSANITY.  297 

in  another,  and  that  the  disease  may  go  through  both  forms  in 
the  same  person  before  it  has  run  its  natural  course.  Clearly 
such  a  classification  of  symptoms  must  be  looked  upon  as  pro- 
visional ;  but  for  the  present  it  is  convenient,  and  in  truth  neces- 
sary. Were  there  no  methodical  classification  of  symptoms,  an 
author  would  be  compelled  on  each  occasion,  when  describing  a 
variety  of  mental  derangement,  to  set  forth  the  symptoms  in 
detail  instead  of  denoting  them  by  the  general  name  of  the 
class,  and  there  would  be  no  end  of  his  labour.  This  necessity 
of  calling  up  by  a  general  term  the  conception  of  a  certain  co- 
existence and  sequence  of  symptoms  is  a  reason  why  the  old 
classification  holds  its  ground  against  classifications  that  are 
alle^jed  to  be  more  scientific :  it  is  ^ood  so  far  as  it  e^oes,  but  it 
by  no  means  goes  to  the  root  of  the  matter ;  whereas  the  classifi- 
cations which  pretend  to  go  to  the  root  of  the  matter  go  beyond 
what  knowledge  warrants,  and  are  radically  faulty. 

Some  persons  exhibit  eccentricities  of  thought,  feeling,  and 
conduct,  which,  not  reaching  the  degree  of  positive  insanity, 
nevertheless  make  them  objects  of  remark  in  the  world,  and 
cause  difficulty  sometimes  when  the  question  of  legal  or  moral 
responsibility  is  concerned.  They  are  so  unlike  other  people  in 
their  feelings  and  thoughts,  and  do  such  odd  things,  that  they 
are  thought  to  have  a  strain  of  madness  in  them;  they  have 
what  may  be  called  the  insane  temperament, — in  other  words, 
a  defective  or  unstable  condition  of  nerve  element,  which  is 
characterised  by  the  disposition  to  sudden,  singular,  and  im- 
pulsive caprices  of  thought,  feeling,  and  conduct.  This  con- 
dition, in  the  causation  of  which  hereditary  taint  is  commonly 
detectable,  may  be  described  as  the  Neurosis  spasmoclica  or 
Neurosis  insana. 

The  Insane  Temperament  or  Neurosis  insana.. 

It  is  characterised  by  singularities  or  eccentricities  of  thought, 
feeling,  and  action.  It  cannot  truly  be  said  of  any  one  so  con- 
stituted that  he  is  mad,  but  he  is  certainly  strange,  or  ''  queer," 
or,  as  it  is  said,  "  not  quite  right."  AVhat  he  does  he  must  often  do 
in  a  different  way  from  all  the  rest  of  the  world.  If  he  thinks  about 
anything,  he  is  apt  to  think  about  it  under  strange  and  novel 


298  PATHOLOGY  OF  MIND.  [chap. 

relations,  wliicli  would  not  have  occurred  to  an  ordinary  person ; 
his  feeling  of  an  event  is  unlike  that  which  other  people  have 
of  it ;  he  has  perhaps  the  strangest  twists  and  cranks  of  thought, 
and  is  given  to  punning  on  words  ;  and  now  and  then  he  does 
whimsical  and  apparently  quite  purposeless  acts.  There  is  in 
the  constitution  an  innate  tendency  to  act  independently  as  an 
element  in  the  social  system,  and  there  is  a  personal  gratification 
in  the  indulgence  of  such  disposition,  which  to  lookers-on  seems 
to  mark  great  self- feeling  and  vanity ;  he,  hoAvever,  is  so  exclu- 
sively engrossed  in  the  affection  of  self  that  he  gratifies  his 
eccentric  impulses  without  being  conscious  of  the  way  in  which 
his  conduct  affects  other  persons.  Such  an  one,  therefore,  is 
looked  upon  by  those  who  perform  their  duties  in  the  social 
system  with  equable  regularity,  thinking  and  feeling  always 
just  as  other  people  think  and  feel,  as  odd,  queer,  strange, 
crochety,  not  quite  right. 

This  peculiarity  of  temperament,  which  is  the  sign  and 
perhaps  the  sanitary  outlet  of  a  predisposition  to  insanity, 
borders  very  closely  upon  genius  in  some  instances ;  it  is  the 
condition  of  the  talent  or  wit  which  is  allied  to  madness,  being- 
only  divided  from  it  by  thin  partitions.  The  novel  mode  of 
looking  at  things  may  be  an  actual  advance  upon  the  accepted 
system  of  thought,  and  occasion  a  flash  of  true  insight;  the 
individual  may  be  in  a  minority  of  one,  not  because  he  sees  less 
than,  or  not  so  well  as,  all  the  world,  but  because  he  happens  to 
see  deeper,  and  to  have  the  intuition  of  some  new  truth.  He 
may  differ  from  all  the  world,  not  because  he  is  wrong  and  all 
the  world  is  right,  but  because  he  is  right  and  all  the  world  is 
wrong.  Of  necessity  every  new  truth  is  at  first  in  a  minority 
of  one ;  it  is  a  deviation  from  or  a  rebellion  against  the  existing 
system  of  belief ;  accordingly,  the  existing  system,  ever  thinking 
itself  a  finality,  strives  with  all  the  weight  of  its  established 
organisation  to  crush  it  out.  By  the  nature  of  things  that  must 
happen,  whether  the  novelty  be  a  truth  or  an  error.  It  is  only 
by  the  work  of  rebels  in  the  social  system  that  progress  is 
achieved,  and  precisely  because  individuality  is  a  reproach,  and 
sneered  at  as  an  eccentricity,  is  it  well  for  the  world,  as  Mr. 
J.  S.  Mill  pointed  out,  that  individuality  or  eccentricity  should 


VII]  THE  SYMPTOMATOLOGY  OF  INSANITY.  299 

exist.^  It  will  not  "be  amiss  to  set  this  matter  forth  at  greater 
length,  to  the  end  that  we  may,  if  possible,  get  a  just  conception 
of  the  real  relation  of  certain  sorts  of  talent  to  insanity. 

The  genius  is  in  the  van  of  his  age :  in  that  wherein  he  is 
ahead  of  it  he  necessarily  differs  from  his  age,  and  is  often- 
times therefore  pronounced  mistakon,  unpractical,  mad  ;  in  that 
wherein  he  agrees  with  his  age,  he  is  necessarily  not  original ; 
and  so  appears  the  truth  of  an  observation  of  Goethe,  that 
genius  is  in  connection  wath  its  century  only  by  its  defects — 
that  in  which  it  is  not  genius.  Certainly  the  originality  of  a 
man  of  true  genius  will  grow  out  of  the  existing  system,  and 
may  be  traced  as  a  genetic  evolution  of  it ;  he  is  in  radical  con- 
nection with  his  century ;  but  the  more  forward  he  has  gone  in 
his  development,  the  more  he  will  outshoot  his  age  and  differ 
from  it.  Accordingly,  many  a  man  of  genius  who  has  appeared 
before  his  time — in  other  words,  before  the  social  organism  has 
reached  that  height  of  evolution  which  his  thought  marks — has 
made  little  impression  upon  the  world,  and  perhaps  been  alto- 
gether overlooked  or  soon  forgotten  by  it,  having  most  likely 
been  thought  more  or  less  mad  in  his  lifetime ;  and  the  person 
who  usually  gets  most  reputation,  and  whose  name  is  made  to 
mark  an  epoch  in  development,  is  he  who  systematises  and 
definitely  sets  forth — that  is,  brings  into  illuminated  conscious- 
ness— the  method  which  mankind  has  for  some  time  been 
instinctively  and  unmethodically  pursuing.  A  Bacon  or  a 
Comte,  being  not  really  much  in  advance  of  his  time,  but  having 
eyes  to  discern  the  tendencies  of  development,  and  a  capacity 
of  co-ordinating  knowledge,  is  he  who  gets  the  most  honour. 
But  even  he  is  not  honoured  so  much  by  his  own  age  as  by  a 
posterity  which  has  grown  to  his  level.  We  never  see  how  high 
the  mountain  is  until  we  get  some  distance  from  it. 

An  inherent  disposition  of  nature  which  renders  a  man  dis- 
satisfied with  the  existing  state  of  things  and  urges  him  to 
novel  strivings,  is  really  an  essential  condition  of  originality : 
to  suffer  greatly,  and  to  react  with  corresponding  force,  being  a 
means  of  dragging  the  world  forward  at  the  cost  of  individual 
comfort.      Consider,  however,  what  an  amount  of  imiate  power 

^  Essay  on  Liherty. 


300  PATHOLOGY  OF  MIND.  [cuap. 

a  man  must  have  in  order  to  do  that,  without  himself  sinking 
under  the  huge  weight  of  opposition  !  Many  eager  and  intense 
reformers,  whose  vital  energies  have  been  swallowed  up  in  the 
passion  and  the  promulgation  of  a  truth,  which  was  perhaps  an 
important  one,  have  notoriously  broken  down  in  face  of  the 
crushing  force  of  the  organised  opposition.  They  have  been  so 
much  engrossed  in  their  idea,  so  carried  away  by  it,  so  blind  to 
the  force  of  the  circumstances  with  which  they  have  had  to 
contend,  so  abandoned  to  its  propagation,  so  one-sided  and 
fanatical,  as  to  be  almost  as  heedless  of  the  manifold  relations 
of  their  surroundings  as  actual  madmen  are ;  accordingly  they 
have  often  been  called,  and  sometimes  perhaps  were,  mad. 
Certainly  their  failures  prove  that  they  had  not  sufficient  in- 
sight, patience,  and  capacity  for  the  task  which  they  had  under- 
taken :  that  they  did  not  succeed  is  scientific  proof  that  they 
did  not  deserve  to  succeed.  Howbeit  they  had  not  imme- 
diate success,  their  work  may  not  have  been  all  in  vain.  The 
heroes  that  have  fallen  in  the  lost  field  of  the  fight  for  the  cause 
that  seemed  to  perish  with  them  have  oftentimes  risen  to 
memory  after  many  years  of  oblivion  during  which  no  man 
spake  of  them;  they  had  struck  a  rift  in  the  false  doctrine, 
and  dropped  a  seedling  of  new  truth  into  it,  which,  as  it  grew, 
opened  gradually  a  wider  and  wider  gap,  and  in  full  time 
shattered  and  silenced  it. 

It  is  undoubtedly  true  that  where  hereditary  taint  exists  in 
a  family  one  member  sometimes  exhibits  considerable  genius, 
when  another  is  insane  or  epileptic.  The  fact  proves  no  more 
than  that  in  both  there  has  been  a  great  natural  sensibility 
which,  under  different  outward  conditions  of  life,  or  different 
internal  conditions  of  body,  has  issued  differently  in  the  two 
cases :  the  one  has  been  better  endowed  by  nature  or  more 
favoured  by  fortune  than  the  other.  We  may  properly  look  at 
the  function  of  unstable  nerve  element  from  two  aspects — first, 
as  regards  the  reception  of  impressions ;  and,  secondly,  as 
regards  the  reaction  to  them.  In  the  first  case  we  may  have 
one  who  is  equal  to  the  ordinary  events  of  a  calm  life,  but  who, 
quick  to  feel  and  slow  to  govern  quick  feeling,  possessing  no 
reserve  force  of  inherited  or  acquired  endurance  and  energy, 


VII.]  THE  SYA[PT0:MAT0L0GY  of  insanity.  301 

incapable  alike  of  a  steady  subordination  of  self  to  events,  and 
of  the  power  to  subordinate  events  to  self,  is  unequal  to  tlie 
strain,  and  breaks  down  under  the  stress  of  adversity.  And  yet 
his  extreme  nervous  susceptibility  may  render  him  sensible  of 
finer  shades  and  more  subtile  delicacies  of  feelinf^  and  thouMit 

o  o 

than  a  more  vigorously  constituted  being  of  coarser  sensibilities 
is.  The  defect,  then,  is  in  some  respects  an  advantage,  although 
a  rather  perilous  one,  since  it  may  go  near  the  edge  of  madness. 
Such  men  as  Edgar  Allan  Poe  and  De  Quincy  illustrate  this 
great  subtility  of  sensibility  amounting  almost  to  disease,  and 
so  far  give  colour  to  the  extravagant-  assertion  of  a  French 
author  (Moreau  de  Tours),  that  a  morbid  state  of  nerve  element 
is  the  condition  of  genius.  It  must  not  be  lost  sight  of,  how- 
ever, that  a  person  so  constituted  is  nowise  an  example  of  the 
highest  genius ;  for  he  lacks,  by  reason  of  his  great  sensibility, 
the  power  of  calm,  steady,  and  comprehensive  mental  assimila- 
tion, and  must  fall  short  of  the  highest  intellectual  develojoment. 
Feeling  events  with  a  too  great  acuteness,  he  is  incapacitated 
from  the  calm  discrimination  of  the  unlike,  and  the  steady 
assimilation  of  the  like,  in  all  sorts  of  them,  grateful  or  ungrate- 
ful, by  which  the  integration  of  the  highest  mental  faculties  is 
accomplished, — by  which,  in  fact,  the  truly  creative  imagination 
of  the  greatest  poet  and  the  powerful  and  almost  intuitive  ratio- 
cination of  the  greatest  philosopher  are  fashioned.  His  insight 
may  be  marvellously  subtile  in  certain  cases,  but  he  is  not 
sound  and  comprehensive.  Albeit  it  might  be  said  by  one  not 
caring  to  be  very  exact  that  the  genius  of  an  acutely  sensitive 
and  subjective  poet  betokened  a  morbid  condition  of  nerve 
element,  yet  no  one,  after  a  moment's  sober  reflection,  would 
venture  to  speak  of  the  genius  of  such  men  as  Shakspeare  and 
Goethe  as  arising  out  of  a  morbid  condition."^     The    impulse 

'  "  So  far  from  the  position  holding  true,  that  great  wit  (or  genius,  in 
our  modem  way  of  speaking)  has  a  necessary  alliance  with  insanity,  the 
greatest  wits,  on  the  contrary,  will  ever  be  found  to  be  the  sanest  writers. 
It  is  impossible  for  the  mind  to  conceive  of  a  mad  Shakspeare.  The 
greatness  of  wit,  by  which  the  poetic  talent  is  here  chiefly  to  be  under- 
stood, manifests  itself  in  the  admirable  balance  of  all  the  faculties.  Mad- 
ness is  the  disproportionate  straining  or  excess  of  any  one  of  them." — 
Sanity  of  True  Genius,  by  Charles  Lamb. 


302  PATHOLOGY  OF  MIND.  •  [chap. 

which  urges  these  men  to  their  high  striving  is  not  so  much 
one  of  dissatisfaction  as  one  of  non-satisfaction — a  craving,  in 
fact,  for  appropriation ;  they  want  to  feel  and  know  ever  more 
and  more  of  nature  in  all  her  multitudinous  moods  and  aspects, 
and  to  get  into  ever  nearer  and  nearer  relations  of  concord  with 
her ;  their  internal  potentialities  speak  by  a  feeling  of  want,  a 
craving,  an  unsatisfied  instinct,  not  otherwise  than  as  the  lower 
orfjanic  elements  manifest  their  sense  of  huncjer,  or  as  the 
sexual  instinct  reveals  its  want  at  puberty.  The  difference 
between  the  desires  which  are  the  motives  to  action  of  the 
highly-endowed,  well-balanced  nature  of  the  genius,  and  the 
desires  which  inspire  the  eccentric  and  violent  acts  of  the  inci- 
pient madman,  is  indeed  very  much  like  the  difference  between 
the  natural  feeling  of  hunger  in  the  healthy  organism,  and  the 
vitiated  appetite  for  garbage  and  dirt  which  the  hysterical 
person  displays  occasionally.  In  the  former  case  the  aspiration 
is  sound,  and  acts  to  perfect  a  harmony  between  the  individual 
and  nature ;  in  the  latter,  it  is  unsound,  and  tends  to  the  pro- 
duction of  an  irreconcilable  discord.  The  good  organisation 
hardly  needs  a  long  training;  it  will  make  the  means  of  its 
own  best  training  by  the  operation  of  its  excellent  affinities; 
and  it  will  thus,  directly  or  circuitously,  attain  to  its  best  de- 
velopment. The  bad  organisation,  on  the  other  hand,  can  only 
be  saved  from  degeneration  by  suitable  training ;  if  unguarded 
by  watchful  control  its  natural  affinities  will  drag  it  downwards 
to  destruction. 

A  no  less  important  difference  between  the  highly-endowed 
nervous  constitution  of  the  genius  and  the  morbid  nervous  con- 
stitution of  the  hereditary  madman  will  appear  when  we  look  to 
the  reactive  instead  of  the  receptive  side.  The  difference  is  not 
unlike  that  which  there  is  between  a  quiet  aim- working  voli- 
tional act  and  a  spasmodic  movement.  The  acts  of  the  genius 
may  be  novel,  transcending  the  established  routine  of  thought 
and  conduct;  but,  however  original  and  startling  they  appear 
to  those  who  work  on  with  automatic  regularity  in  the  social 
organisation,  they  contain,  consciously  or  unconsciously,  well- 
formed  design :  implicit  in  them  are  the  intuitive  recognition  of 
and  the  intelligent  respondence  to  outward  relations ;  in  other 


vii.]  THE  SYMPTOMATOLOGY  OF  INSAKITY.  303 

words,  they  are  aim-working  for  the  satisfaction  of  an  inherent 
impulse,  which  operates  none  the  less  wisely  because  there  may 
not  be  a  distinct  consciousness  of  its  nature  and  aim.  Inspira- 
tion is  the  exact  opposite  in  this  regard  of  hahit  or  custom — that 
"  tyrant  custom  "  which  completely  enslaves  the  whole  manner 
of  thought  and  action  of  the  majority  of  men :  in  the  inspiration 
of  a  great  thought  or  deed  there  is  the  sudden  starting  forth  into 
consciousness  of  a  new  combination  of  elements  unconsciously 
present  in  the  mind ;  these  having  been  steadily  fashioned  and 
matured  through  previous  experience.  On  the  other  hand,  the 
acts  of  the  person  who  has  the  evil  heritage  of  an  insane  tem- 
perament are  irregular,  capricious,  impulsive,  and  aim  at  the 
satisfaction  of  no  beneficial  desire ;  the  outcome  of  a  predisposi- 
tion which  is  itself  the  materialisation  of  ancestral  irregularities, 
they  tend  to  increase  that  discord  between  himself  and  nature 
of  which  the  aberrant  acts  are  themselves  evidence,  and  they 
must  end.  at  last  in  his  destruction. 

I  have  lingered  thus  upon  the  relations  which  a  form  of 
talent  bears  to  insanity,  in  order  to  mark,  if  possible,  the 
character  of  each — so  like  on  the  surface,  at  bottom  so  unlike — 
and  its  true  position  in  the  social  organisation.  A  large  genius 
is  plainly  not  in  the  least  akin  to  madness ;  but  between  these 
widely  separated  conditions  a  series  of  connections  is  made  by 
persons  who  stand  out  from  the  throng  of  men  by  the  possession 
of  special  talents  in  particular  lines  of  development;  and  it  is 
they  who,  displaying  a  mixture  of  madness  and  genius  at  the 
same  time,  have  given  rise  to  the  opinion  that  great  wit  is  allied 
to  madness.  They  are  said  perhaps  to  have  too  much  imagina- 
tion ;  by  which  is  meant  not  that  they  have  a  large,  calm,  well- 
stored,  and  truly  informed  imagination,  but  a  narrow,  intense, 
ill  informed  imagination  that  works  wildly  without  due  nourish- 
ment of  facts  and  undisciplined  by  habitual  obedience  to  law — 
in  other  words,  a  one-sided  and  defective  imagination.^     With 

^  There  never  was  a  truly  great  imagination  without  great  understand- 
ing :  and  it  is  ridiculous  to  attempt  to  separate  them.  To  say  that  women 
have  more  imagination  than  men,  and  that  the  savage  has  more  imagina- 
tion than  the  civihsed  man,  is  nonsense ;  for  it  is  to  call  by  the  higher 
name  what  is  a  negation  of  the  best  imagination,  and  the  product  of  in- 
tellectual barrenness  and  want  of  training  in  observation  and  reflection. 

14 


304  PATHOLOGY  OF  MIND.  [ciiap. 

true  genius  there  may  be  an  uncommon  deviation  from  the  usual 
course  of  things ;  but  there  is  the  full  recognition  of  the  existing 
organisation  as  the  basis  of  a  higher  development,  a  fusing  of  the 
past  through  a  new  mould  into  the  future ;  in  insanity  thei^  is  a 
capricious  rebellion,  as  the  initiation  of  a  hopeless  discord.  A 
man  of  deep  insight  and  comprehensive  vievi^  may  penetrate  be- 
neath the  masks  of  things,  and  see  into  the  real  nature  of  many 
of  the  illusions  set  up  by  common  consent  to  be  worshipped, 
but  he  still  finds  a  real  truth  and  meanincf  beneath  the  fleetine: 
phenomena,  and  he  accepts  with  equanimity  the  present,  not  as 
the  end,  but  as  means  to  an  end,  perceiving  in  it  the  prophecy  of 
a  completer  future :  he  subordinates  his  self-hood  to  the  system, 
works  quietly  and  sincerely  in  his  sphere,  and  is  moved  by  no 
passion  springing  from  offended  self-love  to  set  the  world  vio- 
lently right.  He  can  perceive  the  urgent  need  of  reform,  and 
long  for  its  coming,  without  going  mad  with  vexation  and  injured 
self-love  because  it  plainly  will  not  come  to  pass  in  his  day  and 
by  his  means.  The  man  of  great  self-feeling,  on  the  other  hand, 
may  penetrate  the  incompleteness,  the  inadequacy,  the  empti- 
ness of  many  existing  doctrines  and  practices,  but  he  is  too  apt 
to  find  the  whole  ridiculous,  not  having  calm  enough  apprehen- 
sion to  lay  hold  of  the  degree  of  truth  which  lies  often  at  the 
bottom  of  seeming  shams  ;  he  deems  himself  thoroughly  emanci- 
pated when  he  is  actually  the  unconscious  slave  of  an  extrava- 
gant self-feeling,  by  reason  of  which  he  is  made  angry  with  the 
comedy  of  life,  is  instant  to  do  some  great  thing,  passionately 
earnest  to  set  the  world  right  with  a  one-sided  vehemence : 
there  is  the  reaction  of  a  great  self-love  which  incapacitates  its 
possessor,  or  rather  its  victim,  from  subordinating  his  self-hood 
to  the  laws  of  the  existing  organisation.  Has  not  Goethe  put 
this  truth  tersely  and  well  in  the  words,  *'  The  man  of  under- 
standing finds  almost  everything  ridiculous ;  the  man  of  reason 
hardly  anything  "  ? 

When  the  heritage  of  an  insane  temperament  exists,  it  will  of 
course  depend  much  on  the  internal  bodily  conditions  and  the 
external  circumstances  of  life  whether  the  mischief  shall  remain 
dormant  or  shall  issue  in  positive  insanity.  In  favourable  cir- 
cumstances it  may  manifest  itself  only  in  harmless  eccentricities 


VII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  305 

and  caprices  ;  but  if  the  person  is  placed  under  conditions 
of  great  excitement,  or  subjected  to  severe  mental  strain,  the 
inherent  propensity  is  apt  to  display  itself  in  an  impulsive 
act  of  violence,  or  in  an  outbreak  of  some  form  of  mental  de- 
ransfement.  One  sees  from  time  to  time  brothers  who  have 
presumably  had  the  same  neurotic  inheritance  go  very  diiferent 
ways,  and  reach  very  different  ends,  in  life,  according  to  the 
different  conditions  on  which  each  has  chanced  to  light;  the 
one  perhaps  gaining  position  and  fortune,  the  other  ending  in 
suicide  or  in  a  lunatic  asylum.  The  great  internal  disturbance 
produced  in  young  girls  at  the  time  of  puberty  is  well  known 
to  be  an  occasional  cause  of  strange  morbid  feelings  and  extra- 
ordinary acts,  particularly  where  the  insane  temperament  exists  : 
in  such  case  irregularities  of  menstruation,  always  apt  enough 
to  disturb  the  mental  equilibrium,  may  give  rise  to  an  outbreak 
of  mania,  or  to  extreme  moral  perversion  more  afflicting  to  the 
patient's  friends  than  mania  because  seemingly  wilful.  The 
stress  of  a  great  disappointment,  or  any  other  of  the  recognised 
causes  of  mental  disease,  will  meet  with  a  powerful  co-operat- 
ing cause  in  the  constitutional  predisposition.  On  this  matter, 
however,  enough  has  already  been  said  when  treating  of  the 
causation  of  insanity. 

A  description  of  the  peculiarities  of  mind  and  body  which 
mark  the  varieties  of  the  insane  temperament  would  assuredly 
be  both  interesting  and  useful.  But  the  study,  wliich  has  yet 
to  be  made,  will  be  difficult,  and  the  description  more  difficult 
still,  for  it  will  mean  the  exact  delineation  of  glances,  gestures, 
attitudes,  turns  of  thought,  of  feeling,  and  of  expression,  which, 
albeit  they  are  distinctly  recognised  when  they  are  seen,  cannot 
well  be  set  forth  by  a  verbal  description. 

A  quality  of  mind  which  is  pretty  well  common  to  all  the 
varieties  of  the  temperament,  but  marks  one  variety  of  it  in 
particular,  is  an  intense  self-feeling,  which  has  various  sorts  of 
expression  in  character.  One  might  name  this  the  ef/oistic 
variety.  Everything  is  looked  at  in  the  light  in  which  it  affects 
self ;  there  is  a,  singular  and  serenely  unconscious  incapacity  to 
look  at  self  or  the  incidents  which  affect  it  from  any  outside 
standpoint.     What  will  be  noted  in  some  instances  is  that  the 


30G  PATHOLOGY  OF  MIND.  [chap. 

self-feeling  widens  to  embrace  the  family  without  going  a  step 
farther  in  expansion.  There  is  then  an  intense  family  feeling ; 
the  members  constitute,  as  it  were,  one  self,  feel  with  one  another 
in  a  close  and  narrow  sympathy,  measure  all  their  doings  and 
other  persons'  doings  by  the  standard  of  family  feeling,  and  are 
little  or  not  at  all  affected  by  the  opinions  which  outsiders  may 
entertain  or  by  the  interests  which  they  may  have.  Such  per- 
sons think  how  things  will  affect  their  sensibilities  and  judge 
them  accordingly,  instead  of  ever  thinking  how  they  may  be 
fitted  to  discipline  and  improve  their  sensibilities,  and  how  well 
it  might  be  that  they  were  used  for  that  end ;  exact  with  serene 
unconsciousness  of  selfishness  the  labour  and  sacrifices  of  others, 
as  if  it  were  in  the  natural  order  of  events  that  they  should  use 
all  men  and  be  used  of  none,  should  be  considered  of  all  and 
should  consider  none ;  are  so  entirely  engulfed  in  exaggerated 
family  feeling  that  they  do  not  perceive  the  family  oddities  and 
failings  of  character,  but  perhaps  look  upon  and  even  foster 
them  as  something  higher  than  the  virtues  of  other  families ; 
are  shut  off  by  their  narrow  sympathies  from  anything  like  a 
large  and  healthy  hold  on  the  wide  and  manifold  interests  of 
human  life,  and  from  the  beneficial  discipline  of  thought  and 
feeling  which  a  wider  experience  would  exert  upon  them. 
Withal  they  are  capable  sometimes  of  extraordinary  self-sacrifice 
for  one  another. 

The  fact  is  that  they  are  too  much  akin  in  character ;  they 
have  been  bred  too  much  alike  ;  the  strain  wants  variety  ; 
and  their  best  chance  to  go  through  life  without  breaking 
down  into  mental  derangement  themselves,  or  without  breeding 
such  derangement  in  the  next  generation,  is  to  be  separated 
widely  from  one  another,  and  to  be  placed  in  different  condi- 
tions of  life,  whereby  more  healthy  differentiations  of  cha- 
racter may  be  produced.  One  notices  perhaps  in  families  of 
this  kind  that  the  member  who  has  been  abroad  in  the  world, 
and  has  mixed  among  men  in  various  parts,  and  participated 
in  their  interests  and  doings,  is  the  only  one  who  displays  a 
fairly  rational  and  healthy  tone  of  mind;  and  for  the  same 
reason  the  men  of  these  families,  who,  being  obliged  in  their 
intercourse  with  the  world  to  check  the  gross  display,  have  so  in 


VII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  307 

some  measure  checked  the  growth,  of  the  hahit  of  morbid 
suspicion  and  exacting  selfishness,  are  better  disciplined  in  mind 
than  the  women  who  stay  at  home  and  nurse  their  narrow 
sympatliies  in  a  narrow  sphere.  Plowever,  let  the  stress  be  great 
enough,  the  fundamental  feeling  will  seldom  fail  to  come  out 
even  in  those  who  have  undergone  the  most  varied  discipline. 

A  more  marked  variety  of   an  insane   temperament  shows 
itself    in   an   extremely  suspicious   and  distrustful  nature;   it 
might   be   named  the  suspicious  variety,  for   the   suspicion  is 
morbidly  acute  and  intense.     Persons  of  this  disposition  often- 
times show  not  less,  if  not  more,  distrust  when  they  meet  with 
fair  and  open  dealing,  which,  is  antipathetic  to  their  natures, 
than  when  they  are  in  face  of  fraud  and  duplicity,  with  which 
their  natures  are  sympathetic ;    not  being  able  to  divine  the 
interested  motive  which  they  cannot  help  believing  to  instigate 
the  most  candid  advice,  they  cannot  digest  it,  and  imagine  it  to 
be  too  deep  and  inscrutable  for  them,  whilst  fraud  is  a  congenial 
flattery  of  their  characters ;  so  it  comes  to  pass  that  they  become 
the  easy  dupes  of  plausible  impostors,  who,  pandering  to  their 
foibles,  play  upon  their  infirmities.     Moreover,  any  strange  doc- 
trine which  is  based  upon  a  distrust  of  what  the  majority  of  men 
believe,  and  is  a  rebellion  against  the  accepted  system  of  thought 
and  practice,  has  a  pathological  attraction  for  their  intensely 
distrustful  natures ;    not  because  they  have  anything  like  an 
adequate  knowledge  of  the  errors  of  what  they  reject  or  of  the 
merits  of  what  they  embrace,  but  simply  because  the  latter  is 
heterodox.     With  this  suspicion  of  others  goes  insincerity  in 
themselves ;  distrustful,  they  are  untrustworthy.     Having  little 
or  no  sympathy  with  their  own  healthy  kind,  they  sometimes 
display  extraordinary  affection  for  a  cat  or  a  dog,  and  arrogate 
to  themselves  a  superior  humanity  because  of  their  greater  affec- 
'  tion  for  animals  than  for  men.     I  need  not  repeat  what  I  said 
formerly   of  the  secret  ways,    the   suspicious  imaginings,   the 
exacting  distrusts,  the  duplicity  of  those  near  relatives  of  insane 
persons  who,  having   this   unhappy  temperament,  ask   advice, 
follow  it  not  faithfully,  and   then  blame  the  giver  when  the 
issue  is  not  happy.     With  the  morbid  habit  of  mind  goes  some- 
times a  corresponding  habit  of  bodily  expression — a  downcast, 


308  PATHOLOGY  OF  MIND.  [chap. 

furtive  glance,  an  unsteady,  vacillating  eye  wliicli  cannot  look 
full  and  frankly  into  another  person's  eye;  a  stealthy,  cat-like 
step  and  sneaking  attitude;  nothing  like  frank  outlook,  erect 
bearing,  firm  and  manly  gait.  In  some  instances  an  effusive  can- 
dour and  an  apologetic  humility  of  manner  beguile  the  unwary 
into  a  belief  of  their  sincerity,  which  is  after  all  perhaps  genuine 
at  the  moment.  Entirely  possessed  for  the  time  by  the  feeling 
which  the  occasion  kindles,  they  express  it  freely ;  their  whole 
conscious  state  is,  as  it  were,  the  vibration  of  the  momentary 
emotion,  an  exclusive  energy ;  but  when  its  flame  subsides,  as  it 
quickly  does,  and  reflection  begins,  their  normal  suspicious 
functions  regain  their  hold,  and  they  act  as  if  the  previous  de- 
monstrative expression  of  feeling  had  been  false  and  hypocritical. 
It  was  as  much  out  of  relation  with  their  normal  mental  func- 
tions as  a  muscular  spasm  is  out  of  relation  with  normal  mus- 
cular action.  Hypocritical  without  doubt  it  was  so  far  as  real 
sincerity  of  tlie  whole  nature  was  concerned,  but  not  quite 
consciously  so  at  the  time. 

It  has  been  noticed  in  several  instances  that  members  of  the 
same  family  who  have  become  insane  have  laboured  under  the 
same  form  of  disease  or  under  similar  actual  delusions.  In  one 
family  three  brothers  and  a  sister,  who  were  all  the  members  of 
it  of  their  generation,  went  mad  one  after  another,  and  they  all 
had  similar  delusions  of  conspiracy  and  persecution.  Their 
mother,  who  was  not  supposed  to  be  insane,  was  the  most 
suspicious  and  distrustful  person  whom  I  have  ever  met :  on 
one  occasion  she  declared  to  me,  in  an  outburst  of  momentary 
sincerity,  that  she  never  trusted  anybody,  for  she  had  been  so 
often  deceived.  There  was  no  reason  to  believe  that  she  had 
fared  worse  in  the  world  in  that  respect  than  other  people,  and 
naturally  her  words  stirred  the  sad  reflection  how  much  better 
for  her  family  it  would  have  been  had  she  trusted  more  and 
suspected  less.^     I  call  to  mind  another  case  in  which  three 

1  This  lady  was  much  hurt,  and  never  forgave  me  for  having  been 
thoroughly  candid  with  her.  She  had  buoyed  herself  up  with  hopes,  that 
had  no  real  foundation,  that  a  demented  son  would  recover,  and  had  gladly 
accepted  the  half  promises  of  cure  which  different  doctors  whom  she  had 
consulted  had  given  her,  abusing  them  afterwards  for  deceiving  her. 
When    T  told  her  that  his  case  was  truly  hopeless,  and  that  she  should 


vii]  THE  SYMPTOMATOLOGY  OF  INSANITY.  309 

sisters  Lecame  insane,  and  all  had  similar  delusions  that  they 
were  poisoned  by  chemical  fumes  and  tortured  by  magnetism  : 
it  was  the  more  remarkable  an  instance  because  they  had 
married  and  had  been  separated  in  their  lives.  Everybody  must 
have  noticed  how  exactly  like  one  another  in  thoughts,  feelings, 
and  ways  two  or  three  maiden  sisters  w^ho  have  always  lived 
toj:jether  become ;  so  that  when  one  of  them  falls  insane  it  is  a 
long  time  before  the  others  perceive  or  acknowledge  it,  and  not 
always  easy  for  an  observer  to  say  offhand  which  is  the  patient. 
A  writer  in  a  German  medical  journal  gives  an  account  of 
a  whole  family  who  became  insane."  The  family  consisted  of 
father,  mother,  and  six  grown-up  children.  From  time  to  time 
they  used  to  appear  before  the  central  authorities  of  the  depart- 
ment to  complain  that  they  had  been  plundered  of  their  property 
by  the  magistrates  of  their  district.  It  was  entirely  a  delusion. 
They  had  shut  themselves  np  in  their  house,  abandoning  the 
cultivation  of  their  laud,  and  would  listen  to  neither  entreaties, 
arguments,  nor  remonstrances  from  their  neighbours,  who  out  ol 
compassion  had  gathered  in  their  crops  for  them.  They  lived  in 
a  miserable  manner,  used  no  fire,  and  washed  their  clothes  with- 
out soap  in  a  neighbouring  brook ;  a  deputation  of  them  going 
from  time  to  time  to  the  authorities  to  complain  of  the  injury 
that  had  been  done  to  them.  This  went  on  for  nine  years. 
Eventually  two  of  the  younger  members  left  home  to  take 
situations,  and  another  died.  At  last,  the  father  died  in  the 
winter  of  want  and  cold,  and  one  winter's  night  the  mother  died 
on  the  road  as  she  was  returning  from  one  of  her  fruitless 
expeditions  to  obtain  redress.  The  three  who  were  left,  two 
sisters  and  a  brother,  were  then  sent  to  a  lunatic  asylum.  One 
of  the  sisters,  who  was  microcephalic  and  somewhat  weak- 
minded,  got  rid  of  her  delusions  of  persecution  at  the  end 
of  eight  months  and  became  a  useful  servant.  Tlie  brother  too 
left  the  asylum  and  obtained  employment;  but  the  eldest  sister 
remained  under  the  influence  of  her  delusion,  and  was  angry  and 

make  her  plans  accordingly,  she  was  indignant,  exclaiming,  ''  Why  do  you 
tell  me  that !  "  and  no  doubt  had  recourse  to  some  one  who  was  willing  to 
deceive  her  again. 

1  ZeitscTirift  f.  PsycJiiairie,  B.  29,  H.  2. 


310  PATHOLOGY  OF  MIND.  [cHAr. 

abusive  when  contradicted.  The  conclusion  of  the  physician  who 
inquired  carefully  into  the  history  of  this  family  was  that  the 
mother  and  daughter  had  been  genuinely  insane,  having  the 
delusion  that  they  were  persecuted,  and  that  they  had  succeeded 
in  infecting  with  it  the  other  members  of  a  not  strong-minded 
family,  who  would  no  doubt  have  escaped  had  the  mother  and 
daughter  been  removed  to  an  asylum  at  the  outset. 

In  the  Annales  MSdico-Psychologiques,  1863,  Dr.  Bonnet  gives 
a  remarkable  account  of  suicidal  insanity  in  twin  brothers, 
Martin  and  Francis.  They  were  robbed  of  300  francs.  One 
morning  afterwards  the  brothers,  who  lived  several  miles  apart, 
had  a  similar  dream  at  the  same  hour,  three  o'clock  A.M.,  and 
awoke  in  great  agitation,  shouting,  "  I  catch  the  thief;  he  is 
injuring  my  brother."  Martin's  agitation  increased;  he  com- 
plained of  violent  pains  in  his  head,  declared  he  was  lost,  and, 
eluding  observation,  ran  to  the  river  and  attempted  to  drown 
himself,  but  was  rescued.  In  the  evening  he  was  removed  to 
an  asylum.  Francis,  who  had  become  calm  after  his  first 
excitement,  shouted  that  his  brother  was  lost,  on  seeing  him 
taken  away,  that  he  was  mistaken  for  the  thief,  that  they  were 
going  to  kill  him;  complained  soon  after  of  violent  pains  in 
his  head,  declared  he  was  lost,  and  attempted  to  drown  himself 
at  the  same  spot  where  his  brother  had  done.  He  was  soon  got 
out  of  the  water,  but  could  not  be  restored.  Martin  died  three 
days  after  his  admission  into  the  asylum,  having  remained  in  a 
continuous  state  of  excitement  unto  the  end.^ 

The  form  of  mental  derangement  which  is  most  likely  to  be 
communicated  in  this  way  by  a  sort  of  infection  or  sympathy  is 
that  which  is  characterised  by  groundless  apprehensions  and 

1  In  different  numbers  of  the  Annales  Medko-Psycliologiques  are  related 
several  cases  of  this  sort  of  communicated  insanity.  Among  the  rest  the 
case  of  twin  sisters,  one  of  whom,  afflicted  with  fears  and  delusions  of 
persecution,  infected  the  other,  who  soon  recovered  her  senses  when 
separated  from  her  sister.  In  the  Annales  Medico- Psychologiques  of  July, 
1875,  is  mentioned  the  case  of  a  French  soldier  who  imagined  himself  son 
of  the  Emperor  of  Austria,  and  that  he  would  be  crowned  in  Paris  or  in 
Rome :  he  travelled  in  Italy,  Spain,  and  France  to  attain  his  end.  His 
twin-brother,  who  accompanied  him  in  his  trarels,  believed  in  his  delusions, 
and  had  exactly  similar  ones,  imagining  that  he  would  be  crowned  at 
liome  Avhen  his  brother  was  crowned  at  Paris. 


vii.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  211 

delusions  of  persecution.  No  wonder,  considering  how  easily 
suspicion  is  stirred  up  in  some  minds,  and  how  quickly,  once 
raised,  it  creates  imaginary  proofs  of  hostility,  and  feeds  itself 
upon  the  delusive  evidences  thereof  How  much  more  is  this  so 
in  the  suspicion  of  the  insane  temperament !  The  explanation 
of  such  infections  is  to  be  sought,  as  before  indicated,  partly  in 
the  essential  likeness  of  nature  in  members  of  the  same  family, 
whereby  they  are  disposed  to  feel  and  think  alike,  and  to  foster 
one  another's  habits  of  thought  and  feeling  by  sympathy ;  and 
partly  in  the  absence  of  external  differentiating  influences,  owing 
to  the  fact  that  they  live  in  the  same  narrow  conditions  of  life, 
have  the  same  mean  hopes  and  fears,  and  pursue  the  same  petty 
ends  by  the  same  means.  By  a  sort  of  pre-established  harmony 
of  nature  their  minds  are  attuned  to  chime  together,  and  they 
naturally  do  so  when  they  are  struck  by  the  same  impressions. 
Habits  of  thought  may  thus  grow  side  by  side  in  two  persons, 
and  at  the  same  rate,  into  a  common  delusion,  or — what  is  more 
likely — the  stronger  character  succeeds  in  impressing  its  delusion 
upon  the  weaker  mind. 

Another  variety  of  the  insane  temperament  is  characterized 
by  extreme  irresolution  and  vacillation ;  it  might  be  truly 
described  as  the  vacillating  or  self -tormenting  variety.  Those 
who  have  this  temperament  are  distressed  beyond  measure 
when  they  have  to  decide  anything,  however  trivial,  cannot 
come  to  a  decision  out  of  apprehension  lest  it  should  be  wrong, 
and  worry  themselves  and  others  with  the  many  times  reiterated 
arguments  for  and  against.  Although  the  decision  is  not  of  the 
least  consequence,  whichever  way  it  goes,  it  causes  them  the 
utmost  mental  tribulation,  and  engages  them  hour  after  hour  in 
over-anxious  considerations  of  a  really  puerile  character;  and 
when  the  decision  has  been  made  there  is  an  instant  fear  tliat  it 
has  been  wrong,  and  an  instant  relapse  into  the  self-torturing 
ingenuity  of  discovering  objections  to  what  has  been  decided 
and  of  conjuring  up  the  best  reasons  in  favour  of  what  was  not 
decided.  Whatever  they  have  done  they  persuade  themselves 
they  ought  not  to  have  done,  and  what  they  have  left  undone 
that  they  think  they  ought  to  have  done.  Thus  they  go  on 
from  day  to  day,  from  month  to  month,  a  plague  to  themselves 


312  PATHOLOGY  OF  MIND.  [miap. 

and  to  others  with  their  brain-sick  scruples  and  fears.  If  it  were 
some  great  thing  concerning  which  they  dubitated  and  wavered, 
one  would  not  think  it  anywise  strange,  for  the  habit  of  thinking, 
Hamlet-like,  too  precisely  over  the  event,  which  sicklies  o'er  the 
native  hue  of  resolution  with  the  pale  cast  of  thought,  belongs 
to  certain  minds  of  great  capacity  in  which  the  intellectual  pre- 
dominates over  the  affective  element;  but  it  is  about  the  meanest 
and  most  insignificant  affairs  of  daily  life,  as,  for  example,  what 
dress  shall  be  put  on,  which  side  of  the  street  they  shall  take, 
whether  they  shall  travel  by  one  train  or  another,  what  order 
shall  be  given  to  the  cook  for  dinner,  and  the  like,  that  they  are 
thus  mightily  concerned.  I  call  to  mind  one  lady,  whose  father 
had  committed  suicide,  and  who  herself,  had  been  afflicted  with 
a  great  weariness  of  life  and  with  frequently  upstarting  ideas 
how  well  it  would  be  if  it  were  over,  who  positively  dreaded  to 
rise  from  her  bed  in  the  morning,  because  of  the  suffering  which 
she  knew  she  must  undergo  in  settling  what  dress  she  would 
wear,  and  who  declared  that  she  went  through  agonies  each 
morning  before  she  could  summon  resolution  to  give  orders  for 
the  day's  dinner;  and  the  case  of  a  gentleman  having  both 
mother  and  brother  hopelessly  insane,  who,  although  he  had  no 
profession,  nor  business,  nor  real  work  of  any  kind,  Avas  rest- 
lessly busy  all  day  in  deliberating  upon  the  trifles  of  domestic 
concern  which  he  did  not  find  time  enough  to  settle.  For  when 
the  matter  had  been  gone  into  fully,  and  all  the  reasons  on  one 
side  and  on  the  other  set  forth  elaborately,  and  the  course  of 
action  at  last  fixed  upon,  he  w-ould,  notwithstanding  that  he 
was  aware  of  his  teasing  infirmity,  begin  again  at  the  beginning 
as  if  nothing  had  been  said. 

Nearly  akin  to  this  variety  of  unsound  temperament  is  that 
in  which  an  idea  or  impulse,  oftentimes  of  a  trivial  or  even 
ridiculous  nature,  springs  up  in  the  mind  and  takes  such  hold  of 
it  that  it  gives  the  person  no  rest  until  he  has  yielded  to  it ;  I 
may  call  it,  for  distinction's  sake,  the  impulsim  variety  of  seK- 
torment.  In  one  case  a  man's  life  was  a  series  of  successive 
struggles  to  resist  ideas  which  were  always  annoying,  oftentimes 
distressing,  and  sometimes  ridiculously  foolish ;  he  must  enter  a 
house  with  a  certain  foot  first,  for  if  he  succeeded  by  a  strong 


VII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  313 

effort  over  liiiiiself  to  conquer  the  whim  by  putting  the  other 
foot  first,  it  was  a  terrible  wrench  to  him,  and  he  had  no  rest  of 
mind  until  he  had  gone  out  of  the  house  and  re-entered  it  with 
the  proper  foot  first ;  he  must  take  particular  notice  of  a  name 
or  of  a  number  over  a  shop-door,  and  if  he  resolutely  turned 
his  eyes  away  as  he  passed  the  door,  he  was  obliged  in  the  end 
to  turn  back  in  order  to  look  at  the  name  or  number,  having 
gone  back  more  than  a  mile  on  one  occasion  to  do  so  after  he 
had  made  a  supreme  effort  to  be  master  of  the  absurd  impulse ; 
if  it  came  into  his  mind  that  he  must  move  a  particular  book  or 
piece  of  paper  on  the  table  for  no  reason  whatever — and  whims 
of  that  kind  were  constantly  coming  into  his  mind — he  had 
learned  by  long  experience  that  he  would  have  no  peace  of  mind 
until  he  succumbed.  He  was  not  an  idle  man  who  had  nothing 
to  do  but  brood  over  these  impulses  and  so  magnify  them,  but 
gained  his  livelihood  by  manual  labour ;  was  moreover  unusually 
intelligent,  and  quite  as  conscious  of  their  morbid  character, 
and  of  the  propriety  of  withstanding  them,  as  any  one  else 
could  be,  but  he  came  of  a  family  in  which  there  was  mental 
disease. 

In  another  case  a  gentleman  of  good  means  and  position, 
having  an  insane  brother,  was  tormented  with  similar  impulses  of 
a  ridiculous  nature.  In  all  outward  seeming  he  was  so  sound  that 
no  one  of  his  acquaintances  except  one  or  two  friends  to  whom  he 
had  confided  his  troubles  had  the  least  notion  how  he  was  afflicted. 
Many  were  his  battles  against  the  tormenting  impulses,  but  he 
was  forced  to  succumb  to  them  in  the  end,  for  after  prolonged 
struggle  he  would  become  extremely  agitated  and  distressed, 
break  out  into  a  violent  perspiration,  and  tremble  as  much  as  if 
he  had  just  had  a  terrible  fright.  Once  when  driving  along  the 
public  road  he  chanced  to  notice  two  stones  on  the  top  of  a  high 
wall,  whereupon  it  instantly  came  into  his  mind  that  he  must 
have  them  down.  The  wall  was  too  high  for  him  to  reach  them, 
and  the  absurdity  of  taking  a  ladder  there  in  the  day-time  in 
order  to  get  at  them  helped  him  to  resist  the  impulse,  which  he 
did  during  w^hat  he  described  as  a  most  miserable  fortnight ;  but 
at  the  end  of  that  time  he  w^ent  secretly  out  of  the  town  by 
night  to  the  wall,  taking  with  him  a  long  whip,  with  the  lash  of 


314  PATHOLOGY  OF  MIND.  [chap. 

whicli  he  succeeded,  after  several  attempts,  in  dragging  the  stones 
down.  After  that  he  had  rest  of  mind  until  a  new  impulse  took 
hold  of  him. 

I  shall  mention  only  one  instance  more  of  this  self -torturing 
habit  of  mind,  which  shows  itself  in  all  sorts  of  whims,  of  the 
absurdity  of  which  the  person  is  perfectly  aware — for  example, 
.  in  thinking  constantly  of  particular  numbers  or  particular  words 
i  and  then  noticing  that  they  appear  with  mysterious  frequency 
on  all  sorts  of  occasions ;  in  asking  himself  the  reason  of  some 
very  common  thing,  and  the  reason  again  of  that,  and  so  going 
back  in  questioning  without  end ;  in  groundless  apprehensions  of 
having  said  or  done  something  which,  although  perfectly  innocent 
of  harm  and  not  of  the  least  consequence,  may  have  injured 
some  one  ;  in  fears  lest  he  should  be  made  to  do  unconsciously  at 
some  time  a  ridiculous  or  improper  act,  to  which  he  feels  an 
impulse  that  he  is  resisting  successfully  for  the  present.  The 
loss  of  control  over  the  ideas  and  feelings  of  which  he  has  such 
painful  experience  brings  home  to  him  the  alarming  conviction 
that  he  is  at  the  mercy  of  an  accident  and  may  be  precipitated 
into  doing  some  day  what  he  apprehends  with  fear  and  trembling ; 
and  he  will  burst  into  tears  and  sob  piteously  as  he  tells  the  sad 
story  of  his  fears  and  struggles. 

The  following  story  is  in  the  w^ords  of  a  gentleman  who  con- 
sulted me,  and  who  had  written  it  out  for  me  when  he  came : — 

"  I  inherit  from  my  father's  family  a  troublesome  liver ;  from  my 
mothers  a  singularly  nervous  temperament,  which  has  exhibited 
itself  in  several  members  of  the  family.  One  of  my  uncles  was 
subject  to  strange  hallucinations,  which  took  what  I  believe  is  the 
not  uncommon  form  of  the  fear  of  a  design  upon  his  life,  even  from 
his  own  family  ;  he  had  also  a  belief  that  some  hostile  supernatural 
agency  was  at  work  to  frustrate  his  designs. 

As  far  back  as  I  can  remember,  my  life  has  been  troubled  by 
some  form  or  other  of  nervous  irritation. 

As  a  very  little  child,  I  remember,  I  attached  a  peculiar  import- 
ance to  certain  numbers  ;  this  or  that  trivial  action  must  be  accom- 
panied by  counting  so  many,  or  the  action  must  be  repeated  so  many 
times ;  later,  certain  of  these  numbers  assumed  a  special  importance  ; 


vii.]  THE  SYMPTOxMATOLOGY  OF  INSANITY.  315 

thre€>,  or  any  multiple,  must  be  avoided  in  ordinai'y  actions  as  being 
in  some  sorb  sacred  to  the  Holy  Trinity.  An  imperative  necessity 
seemed  laid  upon  me  to  touch  or  move  this  or  that  object,  though 
I  might  have  no  desire  to  do  so  ;  and,  as  I  think  is  related  of  Dr. 
Johnson,  I  would  submit  to  no  little  inconvenience  to  avoid  tread- 
ing upon  the  joins  of  the  paving  stones.  Generally  I  may  say  that 
that  which  was  least  pleasant  seemed  most  strongly  obligatory ;  for 
example,  if  I  chanced  to  be  walking  with  any  one,  the  impulse  to 
pick  up  a  chance  straw  in  the  path  was  greatly  stronger  than  if  I 
were  alone,  though  (or  perhaps,  because)  I  was  very  sensitive  to  fear 
of  my  peculiarities  being  known ;  and,  again,  though  I  was  fantas- 
tically particular  as  to  cleanliness,  I  was  especially  impelled  to  touch 
some  dirty  or  offensive  object.  I  remember  putting  myself  to  con- 
siderable trouble  to  go  out  again  after  reaching  home  to  move  some 
trifling  thing  I  had  chanced  to  notice  on  the  pavement.  To  resi.-t 
these  impulses  was  very  painful,  though  to  yield  was  of  little  ad- 
vantage, as  the  one  satisfied  was  quickly  followed  by  another.  I 
read,  as  I  remember,  one  of  those  weird  German  tales,  which  made 
a  strong  impression  upon  my  mind  ;  it  was  the  story  of  one  of  those 
compacts  with  the  devil  which  form  the  subject  of  so  many  legends  ; 
the  one,  I  think,  on  which  Ber  Freischutz  is  founded.  For  a  long 
time  the  formula  which  was  to  constitute  the  contract  was  constantly 
recTU'ring  to  my  thoughts,  and  a  sort  of  necessity  seemed  imposed 
upon  me  to  give  it  mental  assent.  As  it  was  necessary  that  it  should 
be  thought,  I  was  obliged,  if  I  may  so  express  myself,  to  think  it 
negatively,  and  so  to  avoid,  as  it  seemed  to  me,  taking  the  terrible 
pledge.  For  a  very  long  time  after  this  particular  fancy  had  lost 
its  hold,  the  phrase  thus  reversed  was  continually  recurring  to  my 
mind.  In  a  similar  way  a  prompting  to  say  or  to  think  some  sen- 
tence of  malediction  against  God  had  to  be  met  by  adding  a  nega- 
tive and  some  expression  of  blessing  or  praise.  Later,  as  a  youth  of 
eighteen  or  thereabouts,  an  imaginary  obligation  under  fancied  oaths 
of  a  terrible  character  to  do  any  trifling  thing  was  the  source  of  no 
little  trouble  to  me.  I  do  not  mean  that  I  believed  that  I  had  at 
some  former  time  taken  such  an  oath,  but  that  the  mere  occurrence 
of  the  thought  of  the  oaths,  though  without  the  assent  of  my  will, 
seemed,  to  my  disordered  sense  of  conscientiousness,  to  make  it 
binding  upon  me ;  under  the  influence  of  this  feeling,  I  would  re- 
peat some  remark  in  conversation  which  I  had  already  made,  I  would 
take  a  tui'ning  in  the  street,  whiv.-li  was  out  of  my  way,  or  buy  an 


316  ■  PATHOLOGY  OF  .MIND.  [chap. 

article  I  saw  in  a  shop  window  for  which  I  had  no  use.  Trifling  as 
such  things  may  seem  in  the  recital,  the  amount  of  inconvenience 
caused  was  often  very  considerable,  and  the  terrible  sense  of  one  of 
these  obligations  unfulfilled  would  cause  me  often  the  most  intense 
unhappiness. 

"Though  these  things  could  scarcely  help  being  noticed,  yet  I 
think  not  even  those  of  my  own  family  ever  knew  the  extent  to 
which  I  was  troubled.  I  was  living,  as  it  were,  a  kind  of  double 
life,  one  part  full  of  wretchedness,  the  other  that  of  a  reserved  and 
studious  boy ;  and  in  spite  of  lengthy  absences  from  school  from 
ill-health,  which  prevented  anything  like  scholarship,  I  was  com- 
monly regarded  as  intelligent  in  ordinary  affairs,  both  at  school  and 
at  home.  For  some  years  after  entering  my  profession,  though  never 
quite  fi^e  from  mental  excitement,  I  was  much  less  disturbed  than 
in  my  boyhood,  so  much  as  to  lead  me  to  hope  that  I  was  growing 
into  a  normal  state  of  mental  health.  For  some  time  past,  however, 
I  have  had  a  recurrence  of  the  old  affection  in  a  new  form.  There 
is,  except  when  the  mind  is  fully  occupied  by  any  quite  engrossing 
employment,  a  prompting  which  reaches  almost  to  a  physical  neces- 
sity, to  give  utterance  to  some  blasphemous  or  obscene  speech.  As 
I  pass  through  the  streets,  or  on  any  one  entering  the  room  in  which  I 
may  be,  some  phrase  of  this  character  presents  itself  to  my  mind, 
and,  as  it  were,  insists  upon  being  spoken  ;  any  conscious  effort  seems 
to  increase  the  evil,  and  evidently,  though  I  am  compelled  to  keep  a 
constant  watch  upon  myself,  that  very  fact  tends  to  increase  the 
nervous  excitement.  I  am  unconscious  sometimes  whether  I  have 
spoken  or  not,  for,  unnatural  as  it  seems,  the  thought  is  so  vividly 
present  to  my  mind,  or  the  uneasiness  it  produces  so  absorbs  my 
whole  attention,  that  I  cannot  trust  either  to  my  own  ears  or  my 
lips.  The  only  sort  of  assurance  I  can  give  myself  is  by  literally 
holding  my  tongue,  the  tip  firmly  between  the  teeth,  and  so  render- 
ing it  physically  impossible  to  utter  distinct  speech." 

The  last  case  which  I  have  to  mention  is  that  of  an  exceedingly 
intelligent  and  accomplished  elderly  gentleman  who  had  served 
with  distinction  in  the  army;  he  had  been  an  opium-eater 
in  his  younger  days,  and  not  temperate  in  other  respects.  He 
had  now  abandoned  the  taking  of  opium,  and  was  most  temperate 
in  habits  and  careful  in  diet.     He  lived  in  two  rooms,  out  of 


VII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  317 

which  he  could  not  bear  to  go,  from  fear  of  occasioning  bodily 
suffering  to  himself  by  exposure  to  sun  or  wind  or  from  some 
other  cause ;  could  not  read  himself,  although  a  well-cultivated 
person,  because  he  thought  it  injured  him  to  do  so,  and  accord- 
ingly engaged  some  one  to  read  to  him  daily.  His  mind  was 
extremely  active,  but  he  was  tormented  by  what  he  called 
"  fads  ; "  something  came  into  his  mind  to  be  said  or  done,  gene- 
rally of  the  most  trifling  nature,  as,  for  example,  to  move  a  lamp 
on  the  table  a  few  inches  from  where  it  stood,  or  to  touch  some 
object  as  he  passed  it,  and  he  had  thereupon  an  irresistible  im- 
pulse to  go  on  repeating  the  act  over  and  over  again ;  however 
long  and  resolutely  he  resisted,  he  was  obliged  to  succumb,  fOr  he 
had  no  peace  of  mind  until  he  did.  He  could  relinquish  a  "  fad  " 
of  this  sort  at  last  in  an  indirect  way  by  writing  it  down  in  a 
book  after  he  had  repeated  it  so  many  times,  and  he  had  accord- 
ingly made  long  records  of  pacified  "  fads  " ;  but  the  misfortune 
was  that  he  had  no  sooner  got  rid  of  one  in  this  way  than  another 
w^ould  take  its  place  and  similarly  harass  him.  He  was  obliged 
thereupon  to  go  through  the  same  process  of  repetition  wdth  it 
until  he  could  turn  it,  so  to  speak,  and  so  get  past  it.  He  had 
consulted  several  physicians  about  his  state,  and  had  taken  counsel 
with  clergymen ;  the  latter  he  had  called  to  his  aid  because, 
being  a  religious  ]3erson,  he  was  unspeakably  tormented  by  ap- 
prehensions that  he  had  not  used  exactly  the  right  word  in  his 
prayers,  and  by  impulses  to  go  on  repeating  words.  Oftentimes 
when  he  touched  something  the  idea  occurred  to  him  that  his 
hands  must  be  soiled,  and  he  felt  that  he  must  then  touch  some- 
thing else,  and  so  was  obliged  to  go  on  touching  one  thing 
after  another  until  he  was  wearied.  In  consequence  of  this  ten- 
dency his  morning  offices  occupied  him  for  along  time  everyday. 
No  one  could  have  had  a  more  exact  knowledge  of  his  state  than 
he  had,  or  perceived  more  clearly  the  absm-dity  of  his  bondage, 
but  he  had  not  the  least  power  to  deliver  himself  from  it. 

Another  mode  of  outcome  of  the  insane  temperament  is  an 
extreme  miserliness.  AVith  a  remarkable  unconsciousness  of 
any  display  of  selfishness  the  individual  tenaciously  claims  and 
takes  and  holds  to  all  he  can  get  in  a  way  which  would  rouse 
some  sense  of  shame  in  a  person  who  had  not  the  temperament ; 


318  PATHOLOGY  OF  MIND.  [chap. 

he,  however,  engrossed  in  the  narrow  desires  of  an  intense  self- 
hood, without  a  touch  of  generosity,  feels  not  the  least  sense  of 
shame.  He  persistently  accumulates  and  lays  up  money  which 
he  needs  not,  without  designing  to  make  any  use  of  it  either  for 
his  own  benefit  or  for  the  benefit  of  others ;  acting  in  fact  as  if 
he  were  carefully  laying  by  stores  which  he  would  take  with  him 
when  he  went  down  to  the  grave  and  have  great  use  of  on  the 
other  side  thereof  He  loses  all  sight  of  the  end  in  the  means, 
and  meanly  toils  for  the  means  as  if  they  were  the  end.  "  Thou 
fool !  this  night  thy  soul  shall  be  required  of  thee,"  would  be  too 
flattering  a  speech  to  one  whose  life  is  proof  of  the  absence  of  a 
soul  in  the  true  sense  of  the  word.  He  is  not  one  with  his  kind ; 
shut  up  in  a  narrow  selfishness,  he  fulfills  not  the  functions  of  a 
sound  element  in  the  social  organisation  ;  he  is  on  the  way  to,  if  he 
does  not  actually  reach,  morbid  degeneracy.  So  long  as  grapes 
do  not  grow  on  thorns  nor  figs  on  thistles,  we  cannot  expect  such 
a  one  to  beget  healthy  children ;  if  he  has  any,  they  will  most 
likely  run  in  either  an  insane  or  a  criminal  groove. 

The  last  variety  of  the  insane  temperament  which  I  shall 
mention  is  that  which  is  characterised  by  a  complete  or  almost 
complete  absence  of  the  moral  sense.  Of  course  the  varieties 
which  have  gone  before  might  in  one  sense  be  called  instances  of 
defective  moral  sense,  but  in  them  there  has  been  an  extravagant 
growth  of  some  egoistic  passion,  the  hypertrophy  of  which  has 
entailed  an  atrophy  of  sound  social  feeling ;  not  an  original 
privation  of  moral  sensibility,  a  moral  imbecility,  such  as  I 
am  convinced  is  sometimes  the  consequence  of  a  bad  descent. 
I  have  already  described  instances  of  young  children  sprung 
from  insane  families  who  have  presented  a  complete  moral 
imbecility,  or  have  precociously  displayed  very  definite  immoral 
tendencies,  and  I  shall  have  occasion,  later  on,  to  describe  a 
genuine  moral  insanity  in  adults,  and  to  point  out  its  hereditary 
antecedents.  Short  of  actual  derangement  which  calls  for  in- 
terference, we  meet  with  all  degrees  of  moral  deficiency  in 
individuals,  and  sometimes  with  an  extraordinary  deficiency 
going  along  with  a  superior  intelligence.  It  is  easy  to  under- 
stand that  this  should  be  when  we  call  to  mind  what  has  been 
said  in  foregoing  pages  concerning  the  evolution  of  the  moral 


VII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  319 

sense  in  mankind ;  concerning  the  fundamental  meaning  of 
insanity  as  an  aberrant  phenomenon ;  concerning  the  near  rela- 
tions which  sometimes  subsist  between  crime  and  insanity ;  and 
lastly  concerning  the  fundamental  characteristic  of  an  insane 
temperament.  This  temperament  really  means  nothing  more  of 
course  than  an  unsound  temperament ;  the  unsoundness  con- 
sists in  some  defect  or  exaggeration  of  qualities  which  unfits 
it  to  adapt  itself  thoroughly  to  its  social  surroundings,  and  so  to 
take  its  proper  part  in  the  social  organisation,  predisposing  it 
-to  go  the  downward  way  of  neurotic  degeneracy  until  an  actual 
morbid  variety  is  produced  either  in  its  generation  or  in  the 
generation  which  follows  it.  It  will  be  found  as  a  matter  of 
experience,  however,  that  the  person  who  has  it  does  not  usually 
go  actually  mad  himself;  he  is  proof  of  madness  in  his  family 
and  is  not  unlikely  to  beget  madness,  but  he  remains  himself 
much  the  same  peculiar  being  all  his  days — near  the  border 
of  madness,  but  not  over  it — and  combining  even  sometimes 
extraordinary  talent  with  his  peculiarities. 

There  is  a  peculiar  infirmity  which  I  have  noticed  once  or 
twice  in  persons  who  have  had  a  marked  neurotic  inheritance, 
namely,  an  inability  to  look  over  a  large  space  such  as  a  wide 
expanse  of  sea  or  plain  without  feeling  very  giddy  and  strangely 
apprensive.  One  gentleman  who  consulted  me  about  the  in- 
sanity of  his  brother  could  never  bear  to  look  from  a  height 
over  a  large  plain  of  country  because  of  the  distressing  vertigo 
which  it  occasioned  him :  it  was  not  any  fear  of  falling  from 
a  height  but  the  spacious  view  which  produced  the  effect,  for 
he  had  the  same  feeling  if  he  were  on  the  sea-shore  or  on  a 
mound  only,  from  which  there  was  no  possibility  of  falling. 
I  observe  that  Eeichenbach  had  noticed  something  of  the  same 
kind  in  some  of  his  so-called  sensitives  :  one  of  them  could 
not  look  at  a  large  plain  because  it  made  her  sick ;  another 
always  avoided  an  open  square,  and  preferred  to  go  through 
the  alleys  rather  than  cross  it ;  to  another  a  waving  field  of 
corn  was  disagreeable,  because  she  felt  as  though  she  were 
being  rocked  by  it  and  would  vomit  if  she  did  not  turn 
away.  Dr.  "Westphal  has  described  as  agoraphobia  a  species  of 
insanity  which   is  characterised  by   the  inability  to   cross  an 


320  PATHOLOGY  OF  MIND.  [chap. 

open  square.  Tlie  condition  marks  a  natural  instability  of  motor 
centres  like  that  which  is  acquired  by  the  drunken  man  who 
steadies  himself  to  cross  a  street  by  fixing  his  eyes  intently  on 
some  object  on  the  opposite  side.  The  vertiginous  feeling  is  the 
subjective  aspect  of  the  instability  of  the  motor  centres. 

With  the  mental  peculiarities  which  mark  an  insane  tempera- 
ment usually  go  peculiarities  of  features,  of  manner,  of  gait, 
and  of  other  bodily  movements  that  are  modes  of  mental  ex- 
pression. Were  we  only  clever  enough  to  read  the  language,  past 
all  doubt  a  man's  mind  might  always  be  discovered  in  his  fea- 
tures and  his  bodily  attitudes.  In  the  insane  temperament 
these  characters  are  oftentimes  so  peculiar  as  to  attract  instant 
notice.  "This  fatal  heritage,"  says  Esquirol,  speaking  of  extreme 
cases,  "  is  painted  upon  the  physiognomy,  on  the  external  form, 
on  the  ideas,  the  passions,  the  habits,  the  inclinations  of  those 
who  are  victims  of  it."  It  is  hard  to  describe  special  traits  of 
address  and  expression,  which  are  nevertheless  easily  perceived 
when  they  are  met  with.  A  so-called  "  nervous  manner,"  which 
is  a  common  enough  expression,  covers  in  reality  a  variety  of 
peculiarities  :  one  person's  address  is  uncertain,  abrupt,  jerky, 
and  when  he  offers  his  hand  it  is  with  the  air  of  a  person  who 
presents  a  pistol  at  you ;  another's  is  shy,  hesitating,  awkward, 
and  instead  of  looking  towards  the  person  whom  he  approaches 
as  he  enters  a  room,  or  whom  he  is  addressing,  he  rolls  his  eyes 
away  strangely  to.  the  right  or  left  or  directs  his  gaze  aimlessly 
to  the  ceiling ;  in  other  cases  the  movements  are  constant,  rest- 
less, purposeless,  or  sometimes  grotesque  and  uncouth. 

There  is  occasionally  a  fixed,  full,  unfathomable  look  or  stare 
which  I  have  noticed  in  the  eyes  of  persons  who  have  inherited 
a  decided  predisposition  to  insanity ;  I  recognise  it,  but  cannot 
describe  it;  it  is  as  though  they  were  preoccupied  with  some 
undercurrent  of  thought  different  from  that  which  is  con- 
cerned in  the  conversation  which  they  are  holding.  One  ieeh 
instinctively  that  what  one  says  to  them  is  not  going  sincerely 
to  the  bottom  of  their  minds,  I  have  noticed  it  particularly  in 
cases  of  mental  depression  in  which  there  has  been  a  suicidal 
feeling,  and  eventually  perhaps  a  suicidal  deed. 

In    some  instances  a  singular   inconsistency  or  incoherence 


VII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  321 

of  features  may  be  noticed ;  one  part  of  the  face  sliall  be 
wreatlied  in  smiles  while  the  rest  of  the  features  are  not  in 
harmony  with  it,  but  have  perhaps  a  grave  and  sober  ex- 
pression ;  or,  in  spite  of  what  i-s  being  talked  about  being  of  a 
serious  nature,  there  may  be  a  nervous  laugh  on  the  face  whitih 
is  quite  out  of  harmony  with  the  mood  of  mind.  Again  I  have 
noticed  sometimes  that  a  smile  or  lauc^li  over  the  face  shall  not 
pass  away  gradually  and  change  into  a  sober  expression,  as  it 
naturally  should,  but  shall  be  arrested  abruptly  in  the  middle 
of  it  and  changed  suddenly  into  a  blank,  abstracted,  and  rather 
vacant  look  of  seriousness,  without  any  corresponding  abrupt 
change  in  the  mental  mood,  so  far  as  can  be  judged.  This 
abrupt  supervention  of  a  vacant  and  abstracted  look  in  the 
midst  of  ordinary  conversation,  without  anything  having  been 
said  to  provoke  it,  may  justly  excite  suspicion  of  a  person's 
heritage.  Lastly,  one  may  remark  in  other  cases  an  extra- 
ordinary mobility  of  features,  which  fall  into  as  many  and 
meaningless  grimaces  as  those  of  an  excited  monkey,  and 
especially  of  the  eyes,  which  roll  about  or  oscillate  aimlessly  as 
if  they  bad  broken  loose  from  the  bonds  of  ordinary  expression 
and  were  making  revolutions  on  their  own  account.  With  such 
grimacing  features  goes  a  grimacing  mind — a  twisted-minded - 
ness,  if  I  may  so  speak.  When  one  eye  rolls  about  out  of 
accord  witb  the  other,  as  it  does  in  some  persons,  I  am  not 
aware  that  it  is  the  mark  of  an  insane  temperament,  but  is  it 
not  associated  frequently  with  a  duplicity  of  character  ?  The 
peculiarities  of  physiognomy  which  I  ha.ve  indicated  seem  to  fall 
mainly  under  two  heads — first,  an  incoherence  between  moods  of 
mind  and  their  natural  facial  expressions,  and,  secondly,  an  in- 
coherence of  the  special  features  which  constitute  the  natural 
expression  of  a  mood — a  sort  of  dislocation  or  discontinuity  of 
muscular  function.  The  mind's  expressions,  like  its  functions, 
evince  a  tendency  to  incoherence. 

These  traits  of  expression  are  consistent  with  sanity  of  mind ; 
they  are  not  adduced  as  evidence  of  actual  mental  derangement, 
but  as  signs  of  a  temperament  which  will  usually  be  seen  on 
inquiry  to  own  a  neurotic  inheritance  or  be  observed  to  found 
one.  But  in  extremer  cases  of  hereditary  degeneracy  the  physical 


322  PATHOLOGY  OF  MIND.  [chap. 

signs  of  defect  are  more  marked.  The  physiognomy  has  not 
regularity  and  harmony,  but  shows  irregularity,  discordance,  or 
actual  distortion  of  features  ;  there  is  sometimes  an  irregular 
conformation  of  the  head,  one  side  of  which  may  be  larger  than, 
or  differently  shaped  from,  the  other ;  the  ears  are  not  well  and 
regularly  planted,  nor  perhaps  properly  formed  in  all  their  parts, 
and  there  may  be  actual  deformity  of  one  or  both  of  them,  as 
Morel  has  pointed  out;  convulsions  have  perhaps  occurred  in 
early  life,  and  some  sort  of  spasmodic  movement  or  tic  of  certain 
muscles  may  continue  throughout  life.  In  the  worst  cases, 
where  degeneracy  has  reached  the  depth  of  imbecility,  the  walk 
is  vacillating  and  uncertain,  and  there  is  sometimes  a  dispro- 
portion between  tlie  limbs.  It  would  be  true  probably  to  say 
that  no  one  who  lacks  power  to  use  and  govern  his  muscles  will 
be  capable  of  good  power  of  attention.  Arrest  of  development 
of  the  sexual  organs  is  not  very  uncommon  ;  slight  diseases 
readily  take  on  a  fatal  ch^aracter,  so  little  is  the  power  of  vital 
resistance ;  and  the  mean  duration  of  life  among  those  strongly 
marked  by  this  fatal  heritage  is  less  than  the  average. 

There  are  corresponding  peculiarities  of  disposition :  Morel,  of 
Rouen,  to  whom  we  are  most  indebted  for  the  scientific  investi- 
gation of  these  victims  of  degeneracy,  described  them  as  purely 
instinctive  beings;  they  display  instinctively  certain  remarkable 
talents,  as  for  music,  drawing,  calculation,  or  exhibit  a  prodigious 
memory  for  details ;  but  they  are  incapable  of  sustained  thought 
and  work — they  cannot  bring  anything  to  a  steady  perfection, 
"  do  not  know  that  they  know,  do  not  think  that  they  think  ;  " 
and  under  any  great  strain  they  are  almost  certain  to  break 
down  into  insanity,  or  to  explode  in  some  act  of  violence.     It  is 
remarkable  nevertheless  how  much  talent  of  a  particular  kind 
may  coexist  sometimes  with  these  extreme  forms  of  degeneracy ; 
as  if  to  show  how  much  of  the  acquisitions  of  countless  ages  of 
mankind  is  now  contained  in  the  most  degenerate  specimens — 
what  an  infinitely  sublimed  heritage  of  eons  of  culture  belongs 
to  the  essence  of  any  human  being  of  civilised  parentage.     I 
once  saw  a  little  girl,  set.  five,  imbecile  from  birth  by  reason  of 
hereditary  degeneracy,  who  could  not  speak  a  word,  screamed 
frightfully,  and  was   so  mischicA^ous   and  destructive  that  she 


ni.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  323 

could  not  be  left  alone  for  a  minute  ;  yet  she  could  hum 
correctly  many  tunes — her  mother  counted  as  many  as  twenty. 
As  the  result  of  his  elaborate  researches,  Morel  came  to  the 
conclusion  that  "  in  the  inferior  varieties  of  deo-enerate  beincrs  a 
like  physical  type  is  to  be  observed  amongst  all  the  individuals 
that  compose  these  varieties,  and  a  certain  conformity  in  their 
intellectual  and  moral  tendencies.  They  betray  their  origin  by 
the  manifestation  of  the  same  character,  the  same  manners,  the 
same  temperament,  the  same  instincts.  These  analogies  establish 
amongst  degenerate  individuals  under  the  same  causes  the  bond 
of  a  pathological  relationship."  Forget  not  tliat  between  the 
extreme  forms  of  this  degeneracy  and  those  slight  eccentricities 
compatible  with  high  talent  there  are  to  be  met  with  cases 
marking  every  shade  of  the  long  gradation. 

Closely  allied  to  the  insane  temperament  is  that  which  exists 
in  those  more  or  less  hysterical  women,  mostly  under  thirty 
years  of  age,  who  are  the  favourite  subjects  of  mesmeric  experi- 
ments and  of  religious  revivals,  and  who  commonly  exhibit  some 
peculiarity  of  nervous  constitution,  such  as  catalepsy,  paralysis, 
somnambulism,  or  spasmodic  affections.  Having  no  well-formed 
will  of  their  own,  they  become  the  easy  victims  of  ideas  forcibly 
impressed  upon  them  by  others.  Their  spasmodic  temperament, 
unfavourable  to  the  proper  co-ordination  of  ideas  and  feelings, 
is  eminently  favourable  to  the  morbid  exaggeration  of  some 
feeling  or  idea  and  to  spasmodic  movements.  A  farther  con- 
sequence of  this  bad  organisation  in  most  of  these  cases  is  a 
strangely  perverted  or  defective  moral  nature.  Certain  women 
exhibit  a  desire  for  and  a  love  of  imposture  which  approaches 
a  moral  insanity  :  will  blacken  their  eyelids  with  some  pigment 
in  order  to  look  and  be  thought  ill,  when  they  are  in  good  bodily 
health ;  will  lie  in  bed  for  months  or  even  years,  affirming  that 
they  are  paralysed,  when  the  only  paralysis  they  have  is  one  of 
moral  energy ;  will  undergo  extraordinary  sufferings  and  priva- 
tions in  order  to  substantiate  some  outrageous  fraud  which  they 
are  practising ;  openly  refuse  all  food  for  weeks,  in  order  to 
produce  the  belief  that  they  live  without  food;  drink  what 
urine  they  clandestinely  pass,  in  order  to  have  it  believed  that 
they  never  pass  any  ;  and  burn  or  blister  their  arms  and  bodies 


324  PATHOLOGY  OF  MIND.  [chap. 

with  some  corrosive  fluid,  in  order  to  fabricate  a  peculiar  skin- 
disease.  The  religious  ecstatics  of  the  middle  ages  belonged 
doubtless  to  this  class  ;  the  miraculous  stigmata  which  they 
exhibfted  beinsj  as  fictitious  as  the  diseases  which  their  sisters 
of  the  present  day  fabricate  or  counterfeit.  When  the  vagaries 
of  hysteria  affect  the  mind  rather  than  the  body,  as  they  are  apt 
to  do  where  the  insane  temperament  exists,  they  occasion  many 
extraordinary  symptoms. 

Hysteria  is  notably  a  very  vague  term  used  to  include  a  mass 
of  functional  nervous  disorders  of  all  sorts  and  degrees,  which 
are  certainly  not  as  distinctly  marked  out  from  one  another  as 
it  is  desirable  they  should  be.  One  character  they  have  in 
common,  namely,  that  they  suggest  the  notion  of  a  counterfeit- 
ing of  disease  :  a  group  or  succession  of  symptoms  which  would 
be  of  grave  omen  otherwise  are  known  not  to  be  of  grave  omen 
when  it  can  be  said  of  them  that  they  are  only  hysterical ; 
wlierefore,  not  having  the  significance  which  they  seem  or  affect 
to  have  as  the  exponents  of  serious  disease,  they  necessarily 
have  the  look  of  pretence  or  feigniug.  The  appearance  of  un- 
reality is  further  strengthened  by  the  fact  that  in  many  cases  the 
malady  can  be  checked  instantly  by  the  will  when  it  is  vigor- 
ously roused  by  a  strong  enough  motive,  and  that  in  other  cases 
it  may  be  gradually  suppressed,  as  will  is  strengthened  steadily 
by  a  suitable  moral  discipline,  such  discipline  being  the  best 
treatment  of  the  malady.  The  two  principal  features  then 
which  attract  notice  in  all  so-called  hysterical  cases  are  a 
seeming  simulation  of  disease  in  protean  forms  and  an  ener- 
vation of  wilL  Let  it  not  be  supposed,  however,  that  the 
simulation  is  voluntary  or  even  conscious  in  the  majority  of 
cases ;  although  the  symptoms  do  not  mark  the  disease  wliich 
they  seem  to  mark,  do  not  mean  epilepsy,  for  example,  when 
they  are  violent  convulsions  of  an  epileptiform  character,  they 
are  none  the  less  the  outcome  of  a  genuine  disorder  of  the 
nervous  system,  and  of  a  disorder  which  is  nearly  allied  to  that 
which  exists  in  catalepsy,  in  ecstasy,  and  in  those  hybrid  forms 
of  convulsive  seizures  which  we  are  at  a  loss  sometimes  whether 
to  call  hysteria  or  genuine  epilepsy. 

For  the  most  part  we  hardly  take  sufficient  account  of  the  fact 


VII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  325 

that  mimicry  is  a  natural  function  of  the  nervous  system,  consti- 
tuting the  very  basis  of  its  culture,  and  that  the  tendency  in  many 
nervous  disorders  is  to  exaggerate  much  and  even  to  simulate 
symptoms,  apart  from  any  question  of  intentional  deceit.  This 
tendency  it  is  which  will  can  combat  and  sometimes  inhibit  or 
hold  entirely  in  check,  whence  the  universal  counsel  to  so-called 
nervous  patients  not  to  give  way  to  distressing  feelings  and  in- 
clinations to  do  nothing,  but  to  fight  against  them  :  it  is  counsel 
easily  given,  but  hard  to  follow,  since  the  misfortune  is  that  the 
disorder  which  strengthens  the  tendency  weakens  the  will,  and 
so  leaves  less  power  to  control  what  is  more  difficult  of  control. 
Be  this  as  it  may,  however,  it  is  plain  that  there  may  be  all 
degrees  of  apparent  or  of  real  simulation  in  different  instances 
— a  gradation,  in  fact,  ranging  from  an  entirely  unconscious 
mimicry  down  to  deliberate  fraud.  AYe  are  in  the  habit  of 
making  in  our  conceptions  so  complete  a  separation  between  the 
physical  and  the  volitional  action  of  the  nervous  system,  looking 
upon  the  will  as  something  constant,  psychical,  and  entirely 
apart,  that  we  cannot  help  holding  that  it  either  absolutely  is 
or  is  not  in  any  given  function ;  we  find  it  hard  or  impossible  to 
conceive  that  it  may  present  all  degrees  of  degradation  and  that 
its  basis  is  truly  physical.  Involuntary  perverse  conduct  of  a 
voluntary  kind,  convulsions  of  voluntary  movements,  perverse 
pleasure  in  self-torture,  are  expressions  which  would  convey  the 
best  notion  of  the  behaviour  of  some  hysterical  patients,  if  they 
were  not  self-contradictory ;  but  self-contradictory  as  they  seem, 
I  am  inclined  to  think  that  they  are  not  so  mutual^  exclusive 
as  the  received  doctrines  of  psychology  would  indicate.  How- 
ever, they  will  certainly  be  thought  bo  ;  for  it  will  be  a  long 
time  yet  before  it  will  be  possible  to  bridge  the  gulf  between 
physiological  conceptions  of  the  functions  of  mind  and  the  usual 
conceptions  of  it. 

Thus  much  concerning  some  peculiarities  of  an  insane  tem- 
perament which  stop  short  of  actual  insanity.  I  go  on  now  to 
treat  of  the  varieties  of  actual  mental  derangement  from  a 
symptomatological  point  of  view. 


326  PATHOLOGY  OF  MIND.  [chap. 

Varieties  of  Symptoms  of  Actual  Insanity. 

A  passing  survey  of  the  inmates  of  a  lunatic  asylum  could 
hardly  fail  to  strike  the  mind  of  an  unskilled  observer  with  the 
perception  of  two  principal  classes  of  opposite  symptoms :  he 
would  notice  that  there  were  some  whose  every  attitude,  word, 
and  thought  betokened  the  deepest  depression  of  mind,  and 
others  who  betrayed  an  opposite  state  of  exaltation  of  mind  in 
their  look,  their  gait,  and  in  everything  which  they  said  and  did. 
These  opposite  symptoms  mark  the  two  great  divisions  of  Melan- 
cholia and  3fania,  which  correspond  again  to  the  two  funda- 
mental affections  of  self  in  which  all  the  passions  have  their 
roots :  on  the  one  hand,  a  painful  affection  of  self  which  shows 
itself  in  sad  feelings,  thoughts,  and  conduct;  and,  on  the  other 
hand,  an  expansion  or  elation  of  self  which  is  expressed  in 
answering  feelings,  thoughts,  and  deeds. 

A  closer  examination  would  show  the  observer  that  while  the 
derangement  of  mind  was  complete  in  some  patients  and  be- 
trayed itself  in  almost  everything  which  they  said  and  did,  in 
others  it  was  limited  apparently  to  a  few  fixed  ideas,  apart  from 
which  they  thought,  felt,  and  acted  very  much  like  other  men. 
Marking  these  differences  by  another  division,  we  have,  first. 
Mania  divided  into  general  and  partial,  the  latter  known  com- 
monly as  Monomania,  because  of  the  opinion  that  the  madness 
is  limited  to  one  subject ;  and  secondly,  Melancholia^  divided 
likewise  into  General  and  Partial,  the  latter,  although  not  now 
commonly  distinguished,  being  what  Esqnirol  described  as 
Lypemania.  In  regard  to  both  these  forms  of  so-called  partial 
insanity  it  may  be  noted  at  once  that  while  the  intellectual  dis- 
order is  certainly  limited  to  a  few  ideas,  the  same  thing  can 
seldom,  if  ever,  be  said  truly  of  the  feelings ;  they  are  more 
generally  and  deeply  affected,  and  yield  a  constant  nourishment 
to  the  delusion  which  is  rooted  in  and  fed  by  them. 

Were  our  observer  to  reside  long  enough  in  the  asylum  to 
watch  the  course  which  these  mental  disorders  went  through, 
he  would  notice  that  there  took  place  in  some  instances  a 
gradually  increasing  failure  of  mental  power  with  an  increasing 
incoherence    of    ideas,    the    feeling    that    inspired    the    delu- 


VII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  327 

sions  waning  in.  force,  while  the  delusions  themselves  persisted 
and  perhaps  became  more  in  number  and  more  extravagant  in 
character.  All  such  cases  of  wreck  of  mind  consequent  upon 
some  other  form  of  insanity  are  grouped  together  under  the 
name  of  Dementia ;  which  means,  therefore,  the  destruction  or 
loss  of  mind,  as  distinguished  from  Amentia,  which  is  used  to 
denote  idiocy,  or  the  privation  of  mind  occasioned  by  causes 
that  have  acted  before  or  soon  after  birth — that  is  to  say,  before 
there  has  been  a  chance  of  its  development.  A  moment's  re- 
flection proves  that  there  must  needs  be  all  degrees  of  dementia 
as  of  amentia,  ranging  from  chronic  mania  or  melancholia,  in 
which  the  first  signs  of  mental  weakness  show  themselves, 
through  varied  conditions  of  incoherence  or  craziness,  down  to 
actual  fatuity  :  in  fact  any  one  might  represent,  if  he  chose,  the 
deepening  degrees  of  mental  deterioration  as  (a)  chronic  mania  ; 
(h)  craziness ;  (c)  fatuity. 

Here  then  appear  the  lines  of  the  symptomatological  classi- 
fication of  Esquirol  which  is  in  practical  use  at  the  present  day. 
"We  have  only  to  add  to  it  General  Paralysis  of  the  Insane,  a 
disease  the  special  characters  of  which  have  been  observed  and 
defined  since  Esquirol's  time,  and  we  have  the  commonly  recog- 
nised varieties  of  mental  derangement.  It  is  obvious  that  they 
are  not  properly  varieties  of  disease  at  all ;  they  are  grouped 
classes  of  symptoms,  all  of  which  may  positively  occur  in  the 
same  patient  at  different  stages,  and  as  different  phases,  of  his 
disease.  For  it  may  commence  in  melancholic  depression,  pass 
thence  into  acute  mania,  go  afterwards  through  a  chronic  stage 
of  depression  or  of  excitement,  and  end  in  dementia.  Such 
might  indeed  be  considered  its  typical  course.  At  the  same  time 
a  patient  will  oftentimes  go  through  his  malady  presenting  only 
one  of  these  well-marked  groups  of  symptoms ;  and  until  we 
know  exactly  the  obscure  constitutional  conditions  which  are  at 
the  bottom  of  the  differences  of  symptoms — of  which  we  know 
nothing  yet — we  cannot  dispense  w4th  a  symptomatological 
classification. 

When  the  phenomena  of  mental  derangement  are  examined 
with  a  more  patient  and  scientific  attention  than  the  unskilled 
observer  is  able  to  give  to  them,  it  is  found  that  the  foregoing 
15 


328  PATHOLOGY  OF  MIND.  [chap. 

classes  do  not  include,  or  rather  do  not  define  adequately,  all  the 
varieties  of  symptoms.  It  is  past  all  question  that  there  are 
certain  distressinsr  and  dant^erous  conditions  of  unsoundness  of 
mind  in  which  the  feelings  and  the  conduct  are  mainly  or  only 
disordered,  the  intellect  being  little  or  not  at  all  affected.  They 
have  been  described  as  insanity  without  delusion,  insanity  of 
feeling  and  conduct,  affective  insanity,  mania  sine  delirio,  melan- 
cholia simplex.  All  these  names  indicate  that  the  perversion 
of  feeling  so  overtops  any  disorder  of  intellect  which  there  may 
be  as  to  attract  predominant  or  exclusive  notice.  Like  the 
recognised  disorders  of  intellect  these  affective  disorders  may 
take  the  form  of  exaltation  or  depression  ;  they  might  therefore 
be  justly  included  in  the  ordinary  groups  of  mania  and  melan- 
cholia ;  but  since  in  common  apprehension  the  terms  mania  and 
melancholia  have  come  to  mean  positive  intellectual  derange- 
ment, and  would  not  adequately  define  these  cases,  which  have 
furthermore  a  medico-legal  interest  and  importance  of  their 
own,  it  is  proper  to  describe  them  separately.  This  is  the  more 
necessary  because  delusion  has  sometimes  been  authoritatively 
proclaimed  to  be  the  criterion  of  insanity.  Most  unwarrantably ; 
for  on  closely  scanning  the  relations  and  the  course  of  develop- 
ment of  the  symptoms  of  mental  derangement  it  will  be  seen 
that  the  affective  disorder  has  been  the  fundamental  trouble  in 
almost  all  cases  that  have  not  been  produced  at  once  by  direct 
physical  injury  ;  that  it  notably  precedes  intellectual  disorder  in 
the  majority  of  cases  ;  that  it  co-exists  with  the  latter  during 
its  course  ;  and  that  it  often  persists  for  a  time  after  this  has 
disappeared.  Esquirol  rightly  declared  ''moral  alienation  to  be 
the  proper  characteristic  of  mental  derangement."  "  There 
are  madmen,"  he  says,  "  in  whom  it  is  difficult  to  find  any  trace 
of  hallucination,  but  there  are  none  in  whom  the  passions  and 
moral  affections  are  not  perverted  and  destroyed.  I  have  in 
this  particular  met  with  no  exception."  To  insist  upon  the 
existence  of  delusion  as  a  criterion  of  insanity,  as  is  done  some- 
times, is  to  ignore  those  most  grave  forms  of  affective  mental 
disease  in  which,  notwithstanding  the  absence  of  positive  intel- 
lectual derangement,  dangerous  impulses  to  homicide,  to  suicide, 
or  to  other  destructive  deeds  are  most  apt  to  arise. 


VII.] 


THE  SYMPTOMATOLOGY  OF  INSANITY. 


329 


It  will  be  most  convenient  then  that  I  should  treat  generally 
of  the  symptomatology  of  insanity  in  the  order  of  the  sub- 
joined classification,  and  afterwards  describe  particularly  the 
principal  clinical  varieties. 


Affective  Insanity  ,    ,    . 

OR 

Insanity  without  Delusion 


Ideational  Insanity 


a.  Instinctive. 
h.  Moral. 


f  Melancholia  j  ;^^^'Te. 
(  Chronic. 


Amentia 


Mania  .     . 

Monomania 
Dementia  . 

Imbecility 
Idiocy  .     , 


Acute. 
Chronic. 

I  Acute. 
)  Chronic 

1  Moral  and 
(  Intellectual. 


I  might  abolish  the  division  of  affective  insanity  altogether, 
and  place  the  varieties  belonging  to  it  under  mania  and  melan- 
cholia, dividing  these  respectively  into  mania  with  delusion  and 
mania  without  delusion,  and  into  melancholia  with  and  without 
delusion ;  but  for  the  reasons  just  mentioned  I  tliink  it  better  to 
classify  them  separately. 


Affective  Insanity  —  Insanity  without  Delusion  —  Insanity  of 

Feeling  and  Action. 

The  feelings  reveal  the  real  nature  of  the  individual ;  it  is 
from  their  depths  that  the  impulses  of  action  spring,  the  func- 
tion of  the  intellect  being  to  guide  and  control.  Consequently 
derangement  of  them  means  a  profound  derangement  of  the 
individual's  nature ;  his  whole  manner  of  feeling^,  the  mode  of 
his  affection  by  objects  and  incidents,  is  perverted  and  unnatural, 
and  the  springs  of  his  action  are  disordered.  The  intellect 
certainly  does  not  escape  entirely,  since  it  is  affected  indirectly 
or  secondarily ;  it  cannot  contemplate  things  in  the  white  light 
of  a  calm  understanding,  but  sees  them  in  the  colours  of  the 
distempered  feelings ;  moreover  it  is  unable  to  check  or  to  control 


330  PATHOLOGY  OF  MIND.  [chap. 

the  morbid  manifestations,  just  as,  when  there  is  disease  of  tlie 
spinal  cord,  a  person  may  be  afflicted  with  convulsive  move- 
ments, of  which  he  is  conscious,  but  which  the  will  cannot 
restrain.  In  dealing  with  this  kind  of  derangement  it  will  be 
most  convenient,  as  in  the  investigation  of  the  insanity  of  early 
life,  to  distinguish  two  varieties — impulsive  or  instinctive  in- 
sanity, and  moral  insanity  proper. 

{a)  Impulsive  Insanity. — Fixing  attention  too  much  upon  the 
insane  impulse,  or  upon  the  act  which  it  instigates,  to  the  neglect 
of  the  fundamental  perversion  of  the  feelings  which  exists  also, 
many  writers  have  helped  unwittingly  to  augment  the  confusion 
and  uncertainty  which  prevail  with  regard  to  these  obscure 
varieties  of  mental  disorder  in  which  violent  insane  impulses 
are  displayed  without  corresponding  insane  thought.  Already 
it  has  been  pointed  out,  at  sufficient  length,  that  the  first  symp- 
tom of  an  oncoming  insanity  commonly  is  an  affection  of  the 
psychical  tone, — in  other  words,  a  perversion  of  the  whole 
manner  of  feeling,  producing  a  marked  change — that  is,  an 
alienation — of  character  and  conduct ;  and  it  will  be  seen  at  a 
later  period  that  morbid  impulses  spring  up  irregularly  and, 
so  far  as  motives  can  be  detected,  unaccountably  in  all  forms  of 
insanity,  and  are  of  the  very  essence  of  the  disease.  What  we 
have  to  fix  in  the  mind  is  that  the  mode  of  affection  of  the  indi- 
vidual by  events  is  entirely  changed  by  the  disordered  state  of 
nerve-element :  this  is  the  fundamental  fact,  from  w^hich  flow 
as  secondary  facts  the  insane  impulses,  whether  mischievous, 
erotic,  .homicidal,  or  suicidal.  In  place  of  that  which  is  for  his 
good  being  agreeable  and  exciting  a  correspondent  desire  to 
acquire  it,  and  that  which  is  injurious  being  painful  and 
exciting  an  answering  desire  to  eschew^  it,  the  evil  impression 
may  be  felt  and  cherished  as  a  good,  and  the  good  impression 
felt  and  eschewed  as  an  evil.  The  morbid  appetites  and  feelings 
of  the  hysterical  woman  and  the  singular  longings  of  pregnancy 
are  mild  examples  of  a  perversion  of  the  manner  of  feeling  and 
desire  w^hich  may  reach  the  outrageous  form  of  morbid  appetite 
exhibited  by  the  pregnant  woman  who  killed  her  husband  and 
pickled  his  body  in  order  to  eat  it.  The  sexual  appetite  may 
likewise   suffer  painful  perversions,  which  of  necessity  involve 


vii.]  THE  SYMPTOxMATOLOGY  OF  INSANITY.  331 

the  destruction  of  all  those  finer  feelings  of  affection  and  pro- 
priety in  the  social  system  that  are  based  upon  it. 

The  morbid  perversion  of  feeling  is  either  general,  when  all 
sorts  and  conditions  of  abnormal  feelings  and  desires  are  exhi- 
bited, or  it  is  specially  displayed  in  some  particular  mode,  when 
one  persistent  morbid  feeling  or  desire  predominates.  AVe  meet 
with  occasional  instances  of  madness  in  which  there  is  a  morbid 
desire  to  be  hanged,  without  particular  intellectual  disorder,  and 
the  victim  of  the  diseased  feeling  is  actually  impelled  to  a  homi- 
cidal act  to  satisfy  his  unnatural  craving  ;  or,  again,  such  insanity 
as  that  of  tlie  father  or  mother  who  in  a  state  of  morbid  gloom 
kills  a  child  from  no  better  motive  than  to  send  it  to  heaven. 
The  act  of  violence,  whatever  form  it  takes,  is  the  outcome  of  a 
deep  morbid  perversion  of  the  nature  of  the  individual ;  a  state 
which  may  at  any  moment  be  excited  into  a  convulsive  activity, 
either  by  a  great  moral  shock,  or  by  some  cause  of  bodily  dis- 
turbance, such  as  intemperance,  sexual  exhaustion,  masturbation, 
or  menstrual  disturbance.  There  are  women,  sober  and  tem- 
perate enough  at  other  times,  who  are  afilicted  with  an  uncon- 
trollable propensity  for  stimulants  at  the  menstrual  periods;  and 
every  large  asylum  furnishes  examples  of  exacerbation  of  in- 
sanity or  epilepsy  coincident  with  that  function.  In  fact,  where 
there  is  a  condition  of  irritable  weakness  or  unstable  equili- 
brium of  nerve  element,  any  cause,  internal  or  external,  exciting 
a  certain  commotion  will  upset  its  stability.  Internal  states 
have  utterance  by  acts  as  well  as  by  speech,  gesture-language 
being  the  primitive  language  of  feeling,  as  natural  a  mode  of 
expression  as  speech  and  prior  to  it  in  the  order  of  development; 
and  it  is  in  insanity  of  action  that  this  form  of  affective  insanity 
is  expressed — most  dangerous,  indeed,  because  so  expressed. 

Many  examples  might  be  quoted  to  illustrate  the  character 
of  this  impulsive  madness  ;  but  a  few  shall  suffice. 

A  married  lady,  aged  thirty-one,  who  had  only  one  child  a 
few  months  old,  was  for  months  afflicted  with  a  strong  and  per- 
sistent suicidal  impulse,  without  any  delusion  or  any  disorder 
of  the  intellect.  After  some  weeks  of  zealous  attention  and 
anxious  care  from  her  relatives,  who  were  all  most  unwilling 
to  send  her  from  among  them,  it  was  found  absolutely  necessary 


332  PATHOLOGY  OF  MIND.  [chap. 

to  send  her  to  an  asylum ;  so  frequent  were  her  suicidal  attempts, 
so  cunningly  devised,  and  so  determined.  On  admission  she 
was  very  wretched  because  of  her  terrible  impulse,  and  often 
wept  bitterly,  deploring  her  own  state  and  the  great  grief  and 
trouble  which  she  was  to  her  friends.  She  was  quite  rational, 
even  in  her  great  horror  and  reprobation  of  the  suicidal  pro- 
pensity ;  all  the  fault  that  could  be  found  with  her  intellect 
was,  that  it  was  enlisted  in  its  service.  With  as  complete  a 
knowledge  of  the  character  of  her  attempts  at  self-destruction 
as  any  indifferent  bystander  could  have,  she  was  powerless  to 
resist  them.  At  times  she  would  seem  quite  cheerful,  so  as  to 
throw  her  attendants  off  their  guard,  and  then  would  make  with 
quick  and  sudden  energy  a  cunningly  precontrived  attempt.  On 
one  occasion  she  secretly  tore  her  night-dress  into  strips  while 
in  bed,  though  an  attendant  was  close  by,  and  was  detected  in 
the  attempt  to  strangle  herself  with  them.  For  some  time  she 
endeavoured  to  starve  herself  by  refusing  all  food,  and  it  was 
necessary  to  feed  her  with  the  stomach-pump.  The  anxiety 
which  she  caused  was  almost  intolerable,  but  no  one  could 
grieve  more  over  her  miserable  state  than  she  did  herself.  From 
time  to  time  she  would  become  cheerful  and  seem  quite  well 
for  a  day  or  two,  but  would  then  relapse  into  as  bad  a  state 
as  ever.  After  she  had  been  in  the  asylum  for  four  months 
she  appeared  to  be  undergoing  a  slow  and  steady  improvement, 
and  it  was  generally  thought,  as  it  was  devoutly  hoped,  that  one 
had  seen  the  last  of  her  attempts  at  self-destruction.  Watch- 
fulness was  somewhat  relaxed,  when  one  night  she  slipped  out 
of  a  door  which  had  been  carelessly  left  unlocked,  climbed  a 
high  garden-wall  with  surprising  agility,  and  ran  off  to  a  reser- 
voir of  water,  into  which  she  threw  herself  headlong.  She  wns 
got  out  before  life  was  quite  extinct ;  and  after  this  all  but 
successful  attempt  she  never  made  another,  but  gradually  re- 
gained her  cheerfulness  and  her  love  of  life.  Her  family  was 
saturated  with  insanity.  In  face  of  such  an  example  of  uncon- 
trollable impulse,  what  a  curious  mockery  of  justice  it  is  to 
measure  the  lunatic's  responsibility  by  his  knowledge  of  right 
and  wrong,  as  some  English  judges  still  think  it  the  perfection 
of  judicial  wisdom  to  do! 


VII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  333 

Such  cases  of  desperate  suicidal  impulse  without  any  manifest 
disorder  of  intellect  are  well  known  to  those  who  take  charge  of 
insane  persons,  and  are  most  unwelcome  to  them ;  for  they  are 
almost  sure  to  succeed  in  the  end  in  doing  what  they  so  fran- 
tically desire,  so  cunningly  plan,  so  resolutely  attempt.  I  have 
known  one  case  of  a  lady,  descended  from  a  very  insane  family, 
who  was  afflicted  with  an  overpowering  impulse  of  the  kind, 
without  the  least  sign  of  any  derangement  of  her  understanding, 
and  who,  after  having  been  frustrated  in  manifold  suicidal  at- 
tempts, was  removed  from  the  asylum  in  which  she  was  residing 
to  another  asylum  where  it  was  thought  the  arrangements  would 
be  more  suitable  to  the  special  care  which  her  case  demanded ; 
but  she  had  not  been  there  long  before  she  succeeded  in  com- 
mitting suicide.  Cases  of  the  kind  are  to  be  distinguished  from 
those  cases  of  ordinary  melancholia  in  which  the  suicidal  feel- 
ing is  common  and  the  suicidal  deed  attempted  from  weariness 
of  life,  from  despair,  or  from  a  delusion  of  some  sort :  in  these 
latter  cases  the  suicidal  impulse  is  one  among  other  symptoms 
of  derangement,  and  has  mostly  a  motive  of  some  sort;  but  in 
the  former  cases  the  suicidal  impulse  is  the  disease,  has  no 
motive,  is  a  sort  of  convulsive  energy  of  the  whole  being,  and 
the  patient's  misery  is  the  result  of  the  horror  and  agony  of 
being  so  dreadfully  possessed. 

Cases  of  the  same  class  occur  in  which  the  morbid  impulse 
is  not  suicidal,  but  homicidal,  and  have  been  recorded  by  differ- 
ent authors.  On  several  occasions  I  have  been  consulted  by  a 
married  lady,  the  mother  of  several  children,  who  is  afflicted 
with  recurring  impulses  to  kill  her  youngest  children,  of  whom 
she  is  most  fond ;  she  cannot  bear  sometimes  to  be  in  the  room 
with  them  when  there  are  knives  on  the  table  and  no  one  else 
is  present ;  and  she  is  driven  to  retire  to  her  bedroom,  where 
she  weeps  in  an  agony  of  despair  because  of  what  she  calls  her 
wicked  thoughts,  and  prays  frantically  to  be  delivered  from 
them.  In  her  paroxysms  of  despair  she  wishes  a  thousand 
times  she  were  dead,  and  exclaims  that  there  can  be  no  God,  or 
He  would  not  allow  her  to  suffer  so.  A  gentleman,  who  is  em- 
ployed in  a  public  office,  has  for  some  time  been  miserable 
because  of  impulses  which  he  has  to  kill  himself  and  his  wife  ; 


334  PATHOLOGY  01'^  MIND.  [chap. 

he  has  gone  into  society,  applied  himself  to  hard  work,  and 
travelled  about  in  order  to  free  himself  from  their  torments,  but 
in  vain ;  and  he  now  consults  me  not  only  that  he  may  be  told 
what  to  do  to  be  delivered  from  them,  but  that  he  may  be  in- 
formed whether  there  is  a  real  danger  that  he  will  some  day 
give  way  to  them.  It  seems  ridiculous,  he  says,  to  sjDeak  of 
them,  but  no  one  can  believe  the  agony  which  they  occasion 
him,  and  the  misery  which  his  life  is  in  consequence.  Another 
gentleman,  who  was  obliged  to  leave  a  hause  near  the  Crystal 
Palace  because  the  high  tower  in  view  provoked  such  vivid 
suggestions  of  suicide  that  he  feared  he  could  not  always  resist 
them  if  he  continued  to  live  near  it,  was  subsequently  afflicted 
with  impulses  to  kill  his  children ;  generally  subactive,  but 
distressing,  from  time  to  time  they  reached  the  height  of  a 
convulsive  mental  paroxysm  and  caused  unspeakable  suffering. 
He  used  to  lock  himself  in  his  bedroom  at  night,  and  put  the 
key  on  the  window-sill  outside  the  window  when  he  went  to 
bed,  so  that  if  he  were  overtaken  unawares  in  the  night  by  a 
paroxysm  he  might  instantly  push  the  key  off  the  sill  beyond 
his  reach  before  he  had  time  to  determine  to  unlock  the  door. 

An  old  lady,  aged  seventy-two,  several  members  of  wdiose 
family  were  insane,  was  afflicted  with  recurring  paroxysms  of 
convulsive  excitement,  in  which  she  always  made  desperate 
attempts  to  strangle  her  daughter,  who  was  very  kind  and  atten- 
tive to  her,  and  of  whom  she  was  very  fond.  Usually  she  sat 
quiet,  depressed  and  moaning  because  of  her  condition,  and  was 
apparently  so  feeble  as  scarcely  to  be  able  to  move.  Suddenly 
she  would  start  up  in  great  excitement,  and,  shrieking  out  that 
she  must  do  it,  make  a  rush  upon  her  daughter  that  she  might 
strangle  her.  During  the  paroxysm  she  was  so  strong,  and 
writhed  so  actively,  that  two  persons  could  scarcely  hold  her ; 
but  after  a  few  minutes  of  struggling  she  sank  down  quite  ex- 
hausted, and,  panting  for  breath,  would  exclaim,  "There,  there ! 
I  told  you ;  you  would  not  believe  how  bad  I  was."  No  one 
ever  detected  any  delusion  in  her  mind ;  the  paroxysm  had  all 
the  appearance  of  a  mental  convulsion ;  and  had  she  succeeded 
in  her  frantic  attempts,  it  would  not  have  been  possible  to  say 
honestly  that  she  did  not  know  that  it  was  wrong  to  strangle 


Vii.]  THE  SYiMPTOMATOLOGY  OF  INSANITY.  335 

her  daiigliter.  In  fact,  it  was  because  of  her  horrible  propensity 
to  so  wrong  an  act  that  she  was  so  wretched. 

In  the  Eeport  of  the  jNIorningside  Asylum  for  1850,  Dr.  Skae 
relates  a  somewhat  similar  case  of  a  female  who  w^as  tormented 
with  "  a  simple  abstract  desire  to  kill,  or  rather  (for  it  took  a 
specific  form)  to  strangle,"  without  any  disorder  of  the  intellec- 
tual powers,  and  who  "  deplored,  in  piteous  terms,  the  horrible 
propensity  under  which  she  laboured."  The  existence  of  this 
kind  of  disease  is  placed  beyond  doubt  by  the  concurrent  testi- 
mony of  all  those  whose  practical  knowledge  of  insanity  gives 
weight  to  their  opinions  and  authority  to  their  words ;  the  denial 
of  it  for  theoretical  reasons  based  upon  the  deliverances  of  a 
sane  self-consciousness  is  reckless  and  unwarrantable.  The  only 
fault  that  can  be  found  with  the  intellect  in  some  of  these  cases 
is,  that  it  is  enlisted  in  the  service  of  the  morbid  propensity, 
devising  means  to  give  it  free  play,  instead  of  devising  means  to 
hold  it  in  check — that  it  is  governed  by  it,  instead  of  governing  it. 

The  next  case  may  serve  to  illustrate  a  multitude  of  insane 
acts  without  corresponding  intellectual  disorder  :  there  was  not 
tlie  impulse  to  any  particular  insane  act,  but  there  were  generally 
perverted  feelings  and  corresponding  impulses  to  different  strange 
and  foolish  acts.  I  quote  it  at  length  because  it  is  a  fair  ex- 
ample of  a  form  of  mental  derangement  which  occurs  not  un- 
frequently  in  young  unmarried  women  who  have  inherited  a 
neurotic  temperament,  and  which  seems  sometimes  to  be  con- 
nected with  unsatisfied  or  wrongly  satisfied  sexual  feelings.  A 
young  lady,  aged  twenty-nine,  of  good  appearance  and  manners, 
and  well  connected,  was,  after  long  and  patient  trial  at  home, 
sent  to  an  asylum.  From  the  age  of  twenty-two  there  had  been 
a  tendency  to  lowness  of  spirits  without  apparent  cause.  Lately 
she  had  become  worse,  and  was  now  described  as  wilful,  im- 
pulsive, passionate,  and  quite  unlike  her  former  self,  having 
lost  all  affection  for  her  parents,  though  formerly  most  affection- 
ate and  amiable.  Her  habit  of  body  was  sluggish,  the  circulation 
being  languid  and  the  extremities  often  cold  and  livid;  men- 
struation was  very  irregular.  She  complained  of  feeling  strange, 
quite  unlike  herself,  and  ill,  and  would  buy  all  kinds  of  queer 
compounds  at   the  chemist's   and  take  them;    sometimes   she 


336  PATHOLOGY  OF  MIND.  [chap. 

wrapped  a  wet  sheet  round  her  body  and  put  her  clothes  od 
over  it.  She  entertained  a  high  opinion  of  her  talents,  waa 
exceedingly  vain,  seeming  to  think  herself  a  peculiar  person, 
and  angrily  complained  that  she  was  treated  most  shamefully  if 
her  inclinations  were  anywise  thwarted.  And  her  inclinations 
were  peculiar,  and  suddenly  manifested:  she  would  all  of  a 
sudden  scale  a  high  garden  wall  and  run  off  into  the  fields,  or 
sit  down  by  the  roadside  when  walking  out,  and  refuse  to  move 
for  a  long  time,  or  stand  still  in  the  middle  of  the  road,  or  jump 
up  in  the  middle  of  the  service  and  walk  out  of  church.  She 
was  continually  writing  letters  to  her  parents,  relatives,  and 
people  whom  she  did  not  know,  complaining  of  her  confinement, 
sometimes  angrily,  at  other  times  humorously.  Usually  the 
letters  were  not  finished,  but  broken  off  abruptly,  sometimes  in 
the  middle  of  a  sentence,  and  sent  for  posting :  one  was  ad- 
dressed to  "  Tout  le  Monde."  They  often  contained  witty  and 
vigorous  remarks,  but  the  sentences  were  rarely  connected,  each 
one  being,  as  it  were,  an  independent  shot ;  as  the  thought  came 
automatically  into  the  mind,  so  it  was  automatically  expressed. 
Now  and  then  she  would  refuse  to  take  any  food  for  a  day  or 
two,  and  at  other  times  would  eat  far  more  than  was  good 
for  her.  She  always  exhibited  extreme  religious  feeling,  was 
fond  of  distributing  tracts  as  she  went  along  the  road,  and 
would  sometimes  read  to  the  unfortunate  patients  who  were 
more  severely  afflicted  ;  notwithstanding  which  benevolence,  she 
would,  if  she  had  not  the  exact  seat  at  church  which  she  mioht 
happen  to  desire,  burst  into  tears  and  sob  with  passion,  or  rise 
up  in  the  midst  of  the  service  and  walk  out ;  at  other  times  she 
would  not  move  after  the  service  was  over,  in  spite  of  all  the 
entreaties  and  reproaches  of  those  who  attended  upon  her.  Ad- 
jured beforehand  to  behave  properly,  she  would  promise  to  try 
to  do  so  ;  remonstrated  with  at  the  time  of  her  extravagances,  or 
after  she  had  indulged  in  them,  the  reply  usually  was  that  her 
motives  were  not  understood ;  when  in  a  better  mood  she  con- 
fessed that  she  was  a  great  trouble,  acknowledged  the  attention 
which  she  received,  and  said  that  she  was  prompted  by  Satan ; 
sometimes  she  wished  heartily  that  some  one  would  give  her  a 
good  beating  so  as  to  rouse  her  from  her  apathy.     If  any  reason 


VII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  337 

was  given  for  her  impulsive  deeds  at  the  time,  it  usually  was 
that  "  it  was  revealed  to  her  "  that  she  was  to  do  so,  by  whicli 
was  plainly  meant  that  it  came  into  her  mind  to  do  so ;  and  it 
was  remarkable  that,  though  usually  overcome  with  languor, 
and  behaving  as  if  scarcely  able  to  move,  she  would,  when  the 
impulse  seized  her,  scale  a  high  brick  wall  with  a  cat-like  agility, 
thouo'h  she  seemed  to  have  no  definite  notion  what  she  was  t^oino- 
to  do  when  she  had  got  over  and  had  run  for  a  certain  distance. 
In  all  her  conduct  she  exhibited  an  odd  combination  of  reason  of 
thought  and  of  dementia  of  action  ;  a  stranger  conversing  with  her 
would  not  have  discovered  that  her  mind  was  at  all  affected  ;  but 
any  one  living  with  her  for  a  time  could  not  feil  to  perceive  how 
exceedingly  insane  she  really  was.  Her  case  might  not  unfitly  be 
described  as  one  of  Dementia  sine  delirio — demented  feeling  and 
conduct  without  intellectual  dementia;  with  good  natural  en- 
dowments and  general  powers  of  reasoning  unimpaired,  there 
was  a  thorough  insanity  of  feeling  and  of  action,  evincing  funda- 
mental derangement  of  her  mental  nature.  Hereditary  taint  was 
denied,  but  it  ultimately  turned  out  that  two  near  rela- 
tives were  in  confinement  and  incurably  insane — a  fact  which 
might  have  been  affirmed  with  confidence  from  the  character  of 
her  disease ;  and  it  is  perhaps  not  uninteresting  to  add  that  an 
uncle  was  the  most  distinguished  architect  of  his  day. 

In  most  of  the  cases  of  this  kind  of  impulsive  or  convulsive 
mental  disorder  it  will  be  found  on  making  careful  inquiry  into 
the  family  history  that  there  is  a  decided  hereditary  taint  -,  and 
in  those  cases  in  which  no  actual  insanity  can  be  detected  by 
inquiry  it  is  probable  that  epilepsy  will  be  found  in  the  family 
or  in  the  individual  himself.  The  two  main  predisposing  con- 
ditions in  which  I  believe  the  disease  to  occur  are — {a)  an 
insane  neurosis,  and  (Id)  an  epileptic  neurosis.  Acting  as  exciting 
causes  in  co-operation  with  the  fundamental  neurosis,  such 
bodily  disturbances  as  irregularities  of  menstruation  will  some- 
times occasion  an  attack  of  the  derans^ement.  A  woman  w^ho 
was  in  the  deepest  despair  because  she  was  afflicted  with  the 
idea  that  she  must  kill  her  children,  and  frequently  ran  actively 
up  and  down  stairs  so  as  to  endeavour  to  drive  away  the  idea 
by  producing  exhaustion,  perfectly  recovered  on  the  return  of 


338  PATHOLOGY  OF  MIND.  [chap. 

the  menses,  wliich  had  stopped.  "We  have,  amongst  others," 
says  Dagonet,  "  observed  a  patient  who  was  seized  at  each  men- 
strual period  with  violent  impulses.  Under  the  influence  of 
this  disposition  she  had  killed  her  three  children  a  short  time 
before  her  arrival  at  Stephansfeld."  ^  Other  occasions  of  bodily 
disturbance,  such  as  pregnancy,  childbirth,  the  climacteric 
change,  may  act  similarly  as  exciting  causes,  as  also  will  moral 
causes  that  have  rapidly  or  by  degrees  produced  great  nervous 
exhaustion  and  irritability.  The  degeneration  of  nerve  element 
induced  by  habits  of  self-abuse,  or  by  great  sexual  excesses, 
sometimes  manifests  itself  in  these  morbid  impulses.  A  gentle- 
man who  was  acute  and  energetic  in  business,  witty  and  agree- 
able in  society,  so  that  he  was  the  life  and  soul  of  every  dinner- 
party he  went  to,  and  was  invited  everywhere,  was  neverthe- 
less so  afflicted  with  disgusting  impulses  to  indecently  expose 
himself,  to  make  indecent  assaults  upon  women  in  the  streets, 
or  to  do  some  other  act  of  obscenity,  that  his  life  was  made 
miserable  ;  he  feared  that  they  might  become  uncontrollable,  since 
they  sometimes  brought  him  to  veritable  despair  and  to  suicidal 
thoughts.  He  was  of  a  highly  nervous  temperament,  having  a 
sister  and  other  members  of  his  family  insane,  and  suffered  from 
spermatorrhoea  and  loss  of  virility.  Lallemand  relates  several 
striking  cases  in  which  patients  suffering  from  spermatorrhoea 
were  afflicted  with  painful  homicidal  and  suicidal  impulses. 

The  most  desperate  instances  of  homicidal  impulses  are  un- 
doubtedly met  with  in  connection  with  epilepsy.  Sometimes  an 
attack  of  mania,  immediately  precedes  an  epileptic  fit  or  a  series 
of  epileptic  fits ;  but  more  often  the  mental  derangement  so 
occurring  has  the  form  of  profound  affective  disorder  with  sud- 
denly arising  impulses  to  violence,  and  with  or  without  corre- 
sponding sudden  hallucinations,  but  without  notable  intellectual 
derangement.  It  is  a  genuine  mania  sine  deliHo.  A  shoemaker 
was  subject  to  severe  epileptic  fits,  and  was  often  furious  for  a 
while  immediately  after  them ;  but  in  the  intervals  he  was 
sensible,  amiable,  and  industrious.  One  day,  while  in  the 
gloomy  and  morose  fram<3  of  mind  that  often  goes  before  and 

1  Traite  ^Umentaire  et  Pratique  des  Maladies  Mentahs,  par  H.  Dagonet, 

1862. 


VII.]  THE  SYxMPTOMATOLOGY  OF  INSANITY.  339 

foretells  an  attack  of  epileptic  fits,  he  met  the  superintendent 
of  the  asylum,  to  whom  he  was  much  attached,  and  suddenly 
stabbed  him  to  the  heart.  He  had  not  had  a  fit  for  three 
weeks,  but  in  the  night  following  his  homicidal  deed  he  had  a 
severe  fit,  and  for  some  time  the  attacks  continued  to  be  fre- 
quent and  severe.  In  such  cases,  as  indeed  there  was  in  this 
case,  there  are  often  sudden  and  vivid  temporary  hallucinations. 

Again,  the  mental  disorder  v/hich  sometimes  takes  the  place 
of  an  epileptic  attack,  being  in  fact  a  masked  epilepsy,  may 
appear  as  simple  impulsive  insanity.  A  peasant,  aged  twenty- 
seven,  had  suffered  from  epilepsy  since  he  was  eight  years  old ; 
but  when  he  was  twenty-five  the  character  of  his  disease  changed, 
and  instead  of  epileptic  attacks  he  was  seized  with  an  irresistible 
impulse  to  commit  murder.  He  felt  the  approach  of  his  out- 
break sometimes  for  days  beforehand,  and  then  begged  to  be 
restrained  in  order  to  prevent  a  crime.  "  AYhen  it  seizes  me," 
he  cried,  "  I  must  kill  some  one,  were  it  only  a  child."  Before 
the  attack  he  complained  of  great  weariness ;  he  could  not 
sleep,  felt  much  depressed,  and  had  slight  convulsive  movements 
of  his  limbs.^ 

The  connection  of  homicidal  insanity  with  epilepsy  is  of  much 
importance  from  a  medico-legal  point  of  view,  and  has  only 
lately  received  the  attention  which  it  deserves ;  it  will  not  be 
amiss,  therefore,  to  give  additional  examples,  and  to  give  them 
in  the  w^ords  of  those  who  have  related  them.  The  first  case  is 
one  mentioned  by  Dr.  Burrows  : — 

''A  very  sober,  quiet,  and  industrious  man,  set.  thirty,  subject  to  oc- 
casional fits  of  epilepsy,  who  had  lately  been  much  inclined  to  religious 
devotion,  was  sitting  calmly  reading  his  Bible,  when  a  female  neigh- 
bour came  in  to  ask  for  a  little  milk.  He  looked  wildly  at  her, 
instantly  seized  a  knife,  and  attacked  her  and  then  his  wife  and 
daughter.  His  aim  appeared  to  be  to  decapitate  them,  as  he  com- 
menced with  each  by  cutting  on  the  nape  of  the  neck."  He  was 
secured,  remained  maniacal  for  three  days,  and  then  recovered, 
"  but  never  had  the  least  recollection  of  the  acts  he  had  committed. 

^  De  la  FoUe  considere  dans  ses  Rapports  avec  les  Questions  Midico-judi- 
ciaires,  par  C.  C.  H.  ]\Iaic. 


340  PATHOLOGY  OF  MIND.  [chap. 

Nine  years  have  since  elapsed  without  a  recurrence  of  the  epilepsy^ 
or  disturbance  of  his  mental  faculties."  ^ 

Griesinger  gives  the  following  instance  of  the  explosion  of  the 
epileptic  aura,  not  in  the  usual  epileptic  seizure,  but  in  terrible 
violence : — 

**  A  man  who  was  a  brandy  drinker  lay  in  a  room  with  his  five 
children,  who  were  that  morning  asleep.  It  came  into  his  mind 
that  he  must  then  destroy  the  children  ;  but  how  could  it  be  most 
conveniently  done  ?  He  said,  '  It  rose  into  my  head  like  foam  ;  it 
went  through  the  chamber  like  a  shot,  or  like  a  strong  gust  of 
wind ;  a  strong  odour  of  marjoram  filled  the  chamber  and  took  away 
my  senses  ;  my  thoughts  vanished,  so  that  I  sank  down.'  He  soon 
rose  again,  however,  seized  an  axe,  and  hacked  right  and  left  among 
the  children,  three  of  whom  fell  victims  to  his  violence.  If  nothing 
else  had  been  known  than  the  deed  and  these  details  furnished 
by  himself,  the  epileptic  might  almost  with  certainty  be  recog- 
nised; but  the  medical  investigation  revealed  actual  and  well-defined 
epileptic  attack."  ^ 

Dr.  Skae  relates  the  instructive  case  which  follows  : — 

"  One  of  the  patients  admitted  afforded  a  highly  instructive  and 
interesting  example  of  homicidal  and  suicidal  impulses  without  any 
intellectual  derangement  or  delusions.  His  case  is  classed  among 
those  of  epileptic  mania ;  for  although  he  never  suffered  from  an 
epileptic  fit  properly  so  called,  he  laboured  under  symptoms  which 
closely  approached  to  those  of  an  epileptic  seizure  of  the  milder  form 
known  as  the  j;e)^i^  mal.  He  described  a  feeling  like  the  aura  epi- 
leptica,  beginning  at  his  toes  and  rising  gradually  upwards  to  his 
chest,  producing  a  sense  of  faintness  and  constriction,  and  then 
going  up  to  his  head,  and  giving  rise  to  a  momentary  loss  of  con- 
sciousness. This  aura  was  accompanied  by  an  involuntary  jerking 
— first  of  the  legs,  then  of  the  arms.  It  was  at  the  times  when  he 
suffered  from  these  attacks  that  he  felt  impelled  to  commit  some  act 
of  violence  to  others  or  to  himself.  On  one  occasion  he  attempted 
to    commit    suicide  by   throwing  himself    into    the   water ;    more 

1  Commentaries  on  Insanity,  p.  156.  The  same  author  mentions  another 
case  in  which  an  attack  of  epileptic  insanity  marked  by  mischievous  ten- 
dencies was  followed  by  an  attack  in  which  murderous  tendencies  were 
displayed. 

2  Introductory  Lecture,  Journal  of  Mental  Science,  1866. 


VII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  341 

frequently  the  impulse  was  to  attack  others,  and  was  at  one  time 
accompanied  by  such  impetuous  violence  that  it  required  the 
strength  of  several  men  to  restrain  him.  He  deplored  his  malady, 
of  which  he  spoke  with  great  intelligence,  giving  all  the  details  of 
his  past  history  and  feelings.  His  attacks,  which  had  been  frequent 
and  severe  at  about  the  ago  of  sixteen  years,  had  for  a  long  time 
almost  disappeared,  but  had  lately  recurred  at  intervals,  until  it 
was  found  necessary  to  send  him  to  the  asylum.  Sleeplessness  and 
constipation  almost  invariably  preceded  his  seizures.  The  state  of 
the  patient  was  greatly  improved  by  the  use  of  bromide  of  potas- 
sium and  other  remedies,  and,  with  the  exception  of  one  or  two 
very  transient  and  slight  attacks,  he  has  kept  well  for  some  months." 
In  a  subsequent  report  he  tells  how  the  case  had  undergone  an  in- 
teresting physiological  development,  "  the  patient  now  having  almost 
daily  a  vivid  spectral  hallucination  in  the  form  of  a  newspaper.  He 
can  see  it  for  a  short  time  so  distinctly  as  to  be  able  to  read  a  long 
paragraph  from  it.  He  continues  to  suffer  from  the  aura  ejnlej^tica 
and  other  symptoms  allied  to  epilepsy."  ^ 

Trousseau  cites  several  instances  out  of  a  number  of  cases 
that  he  has  seen  in  which  the  vertigo  of  epilepsy  was  followed 
by  transitory  fury,  during  which  violence  was  done  without  any 
recollection  afterwards  of  what  had  happened.  Indeed  he 
asserts  that  "  sudden  and  irresistible  impulses  are  of  usual  oc- 
currence after  an  attack  of  petit  mal,  and  pretty  frequent  after  a 
regular  convulsive  fit."  ^ 

I  have  already  alluded  incidentally  to  the  profound  moral  or 
affective  disturbance  which  oftentimes  goes  before  epileptic  con- 
vulsions. The  patient  who  at  other  times  is  cheerful,  amiable, 
industrious,  and  pleased  to  converse,  is  now  all  of  a  sudden 
quite  changed  in  character;  he  becomes  moody,  morose,  sus- 
picious, apprehensive  of  calamity,  leaves  off  work,  and,  if 
addressed,  answers  surlily,  or  not  at  all,  or  only  with  a  blow. 
Ilis  mental  atmosphere  is  charged  with  sullen,  gloomy  feeling, 
which  is  discharged  (a)  by  the  convulsions  which  follow,  as  a 
thundercloud  is  discharged  by  the  thunderstorm,  and  after  their 

^  Report  of  the  Edinhurgh  Asylum^  1866. 

2  Lectures  on  Clinical  Medicine.     By  A.  Trousseau. 


342  PATHOLOGY  OF  MIND.  [chap. 

effects  have  passed  off  he  returns  to  his  natural  state  of  amia- 
bility. But  in  some  cases  there  shall  he  no  convulsions :  instead 
of  them  (b)  a  violent  mania  ensues — an  ideational  in  lieu  of  a 
motor  discharge ;  and  in  a  few  other  cases  (c)  a  convulsive  im- 
pulse to  violence  is  the  channel  of  discharge,  which  may  then 
be  as  uncontrollable  as  the  convulsions  or  the  mania  that  are 
the  two  other  modes  of  discharge.  Let  this  also  be  noted  well 
— that  not  only  may  epileptic  insanity  appear  as  homicidal 
impulse,  but  that  in  this  form  it  may  go  before,  take  the  place 
of,  or  follow  the  usual  convulsions. 

Because  the  deep  perversion  of  the  whole  manner  of  feeling 
which  commonly  exists  in  these  cases  has  been  overlooked, 
attention  being  fixed  exclusively  on  the  morbid  act,  a  great  re- 
pugnance has  been  excited  in  the  public  mind  to  admit  what 
seemed  to  be  the  dangerous  theory  of  instinctive  insanity.  The 
vv^ord  "  instinctive,"  again,  was  not  well  chosen,  since  it  naturally 
seemed  absurd  to  imply  that  there  is  in  man  an  instinct  to 
commit  homicide  or  suicide.  Moreover,  it  is  quite  evident  in 
some  cases  of  impulsive  insanity  that  the  sufferer  has  the  idea 
that  he  must  kill  some  one ;  the  idea  starts  up  involuntarily 
in  a  mind  whose  affective  nature  is  profoundly  deranged,  and 
becomes  convulsive ;  he  is  conscious  of  the  horrible  nature  of 
it,  struggles  to  escape  from  it,  and  is  miserable  with  the  fear 
that  it  may  at  any  moment  prove  too  strong  for  his  will,  and 
hurry  him  into  a  deed  which  he  dreads,  yet  cannot  help  dwell- 
ing upon.  He  never  feels  sure  of  himself.  So  desperate  some- 
times is  the  fear  of  yielding  to  the  morbid  impulse,  so  intense 
the  horror  of  doing  so,  and  so  extreme  the  mental  agony,  that  a 
mother,  afflicted  with  the  impulse  to  kill  her  child,  has  killed 
herself  to  prevent  a  worse  consummation.  In  most  cases  the 
patient  succeeds  in  controlling  the  morbid  idea  by  calling  up 
other  ideas  to  counteract  it,  or  warns  his  probable  victim  to 
get  out  of  the  way,  or  gets  out  of  his  way  himself,  or  begs 
earnestly  to  be  put  under  some  restraint ;  but  it  may  happen 
at  last  that  owing  to  perhaps  a  further  deterioi'ation  of  nervous 
element  through  bodily  disturbance  the  morbid  idea  acquires  a 
fatal  predominance ;  the  tension  of  it  becomes  excessive ;  it  is 
no  longer  an  idea,  the  relations  of  which  he  can  contemplate, 


VII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  343 

but  a  violent  and  exclusive  impulse,  in  which  the  whole  mind  is 
engulphed,  and  which  utters  itself  irresistibly  in  action. 

That  a  person  so  afflicted  can,  and  sometimes  does,  resist  the 
diseased  idea  or  impulse,  causes  many  to  think,  and  some  to 
argue,  that  it  might  always  be  successfully  resisted.  The  word 
irresistible  offends  much  their  theoretical  notions  of  the  power 
and  dignity  of  human  will.  The  truth  is  that  it  is  a  simple 
question  of  the  degree  of  morbid  degeneration  of  nerve  element 
whether  the  idea  shall  remain  in  consciousness  and  be  under 
subjection,  or  become  uncontrollable  and  realise  its  energy  in 
action ;  and  bodily  conditions  will  very  much  affect  that  ques- 
tion. By  an  act  of  the  will  a  person  may  prevent  involuntary 
movement  of  his  limbs  when  the  soles  of  his  feet  are  tickled, 
but  the  strongest  will  cannot  prevent  spasmodic  movements 
of  the  limbs  on  tickling  the  feet  if  the  excitability  of  the  spinal 
cord  be  increased  by  strychnia  or  by  disease.  The  experience 
of  the  desperate  homicidal  impulse  of  epilepsy  is  proof  enough 
that  the  impulse  is  sometimes  beyond  all  doubt  uncontrollable. 
It  is  impossible  that  true  conceptions  of  mental  disease  can  be 
acquired  until  men  cease  to  regard  its  phenomena  entirely  from 
a  psychological  point  of  view,  and  consent  to  study  them  by  aid 
of  the  established  principles  of  physiology  and  pathology.  So 
long  as  they  judge  them  by  the  revelations  of  sane  self-conscious- 
ness, they  do  what  is  not  a  whit  less  absurd  than  it  would  be  to 
base  conclusions  concerning  convulsions  on  the  recognised  power 
of  the  will  over  voluntary  movements. 

The  behaviour  of  a  person  who,  carried  away  by  an  uncon- 
trolled impulse,  has  done  a  homicide,  after  the  convulsive  par- 
oxysm is  over,  may  show  something  like  a  positive  sense  of 
relief.  He  is  perhaps  a  little  dazed  and  stupefied  at  first  before 
he  comes  to  himself  and  realises  what  he  has  done,  but  when 
he  has  come  to  himself  he  does  not  evince  the  horror  and  re- 
morse which  might  be  expected ;  the  reasons  whereof  I  conceive 
to  be, — first,  because  his  previous  mental  agony  was  so  great 
that  his  present  state  is  a  relief  by  comparison.  He  would  will- 
ingly have  been  hanged  twice  over,  if  that  were  possible,  to 
escape  from  his  horrible  impulse  before  he  yielded  to  it :  how, 
then,  can  he  fear  or  much  care  what  may  happen  to  him  after 


344  TATIIOLOGY  OF  MIND.  [chap. 

he  has  done  so  ?  Secondly,  because  he  feels  that  he  was  truly 
possessed  by  a  demoniacal  impulse  which  was  not  himself,  and 
that  what  he  did  in  consequence,  being  done  under  superior 
compulsion,  or,  as  it  were,  in  a  dream,  was  not  really  his  deed 
any  more  than  had  it  been  actually  done  in  a  dream  or  by  an 
evil  spirit  that  had  seized  upon  his  will.  In  other  cases  there 
is  plainly  no  more  than  a  vague,  hazy,  dreamlike  consciousness 
of  what  has  been  done ;  while  in  a  few  cases  there  would  seem 
to  be  a  complete  forgetfulness  of  the  actual  paroxysm.  I  am 
unable  to  say  from  personal  knowledge  whether  such  a  patient 
would  try  to  hide  his  deed  or  to  escape  from  the  consequences 
of  it  when  he  came  to  realise  its  character ;  he  might  or  might 
not ;  but  in  any  case  probably  his  course  would  be  decided  more 
by  his  own  character  than  by  the  character  of  his  disease. 

Before  passing  from  the  consideration  of  the  different  varieties 
of  impulsive  insanity  I  ought  to  mention  that  there  are  some- 
times manifested  other  morbid  impulses  which  have  special  names 
given  to  them — for  example,  an  impulse  to  set  fire  to  property 
or  a  so-called  Pyromania,  an  impulse  to  steal  or  a  Kle])tomania^  a 
frantic  erotic  impulse  or  an  Erotomania,  and  the  like.  It  will  be 
found,  I  think,  that  the  impulses  to  steal  and  to  set  fire  to 
property  usually  go  along  with  some  degree  of  mental  imbe- 
cility, the  persons  manifesting  them  being  at  any  rate  true  moral 
imbeciles ;  but  they  are  sometimes  manifested  by  young  women 
of  average  understanding  at  or  after  puberty,  when  they  are 
undergoing  the  mental  revolution  which  accompanies  sexual 
evolution.  From  time  to  time  one  hears  of  cases  in  which  such 
women  have  set  fire  to  their  masters*  houses  in  a  fit  of  ill- 
humour,  or  have  strangled  or  poisoned  their  masters'  children 
rather  than  be  at  the  trouble  to  take  care  of  them,  or  have  done 
some  other  act  out  of  all  proportion  to  its  motive,  or  without  any 
other  motive  than  the  reckless  relief  of  a  painful  mood.  In  the 
same  way  a  youth  sets  lire  to  a  haystack,  not  out  of  revenge, 
but  merely  to  gratify  a  destructive  impulse  springing  from  a 
present  morbid  mood,  or  makes  a  criminal  assault  upon  a  woman, 
or  commits  suicide  without  apparent  motive.  Careful  inquiry 
in  these  cases  will  commonly  disclose  either  a  measure  of  actual 
imbecility  or  the  existence  of  a  decided  predisposition  to  mental 


VII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  345 

derangement.  The  cases  occupy  the  borderland  between  crime 
and  insanity :  whether  they  are  unsound  enough  to  be  treated 
as  insane  and  irresponsible,  or  sound  enough  to  be  treated  as 
sane  and  criminal,  must  be  settled,  not  by  any  general  rule,  but 
by  the  particular  consideration  of  each  case  on  its  merits. 

(h)  Moral  Insanity. — Here  the  moral  perversion  is  evident 
and  cannot  be  overlooked,  while  the  acts  of  the  individual,  being 
less  convulsive  in  character,  answer  more  exactly  to  the  morbid 
feelings  and  desires  than  they  seem  to  do  in  impulsive  insanity. 
They  look  so  witting  and  wilful  that  it  is  difficult  to  eschew  the 
suspicion  that  moral  insanity  is  anything  more  than  vice.  Much 
as  the  assumption  of  it  as  a  disease  has  been  reprobated,  proper 
w^eight  must  be  given  to  the  fact  that  all  the  eminent  men  who 
have  had  practical  knowledge  of  insanity,  and  whose  authority 
we  habitually  accept,  are  entirely  agreed  as  to  the  existence  of 
a  form  of  mental  disorder  in  which,  wdthout  hallucination,  illu- 
sion, or  delusion,  the  symptoms  are  exhibited  in  a  perverted 
state  of  those  mental  faculties  that  are  usually  called  the  active 
and  moral  powers,  or  included  under  feeling  and  volition — that 
is  to  say,  the  feelings,  affections,  propensities,  temper,  habits,  and 
conduct.  As,  however,  feeling  lies  deeper  in  the  mind  than 
thought,  the  understanding  is  not  entirely  unaffected,  albeit 
there  may  certainly  be  no  positive  delusion  :  the  wdiole  manner 
of  thinking  and  reasoning  concerning  self  is  tainted  by  the 
morbid  self-feeling.  The  person  may  judge  correctly  of  the 
relations  of  external  objects  and  events,  and  may  reason  very 
acutely  with  regard  to  them  ;  but  no  sooner  is  self  deeply  con- 
cerned, his  real  nature  touched  to  the  quick,  than  he  displays  in 
reasoninjT  the  vicious  influence  of  his  morbid  feelincrs  and  an 
answ^ering  perversion  of  judgment.  He  sees  everything  from 
the  standpoint  of  the  narrowest  selfishness,  gratifies  each  vicious 
desire  of  the  moment  without  the  least  sense  of  shame  or  thouoht 
of  prudence,  extenuates  and  excuses  or  justifies  his  bad  conduct 
as  if  others  and  not  he  were  to  blame  for  it,  and  lies  most  shame- 
lessly and  plausibly ;  leading  in  the  end  a  life  of  suffering  and 
shame  w^hich  a  low  prudential  self-regard,  were  he  capable  of  it, 
would  make  him  perceive  to  be  folly.  He  cannot  truly  realise 
his  relations  as  an  element  in  the  social  system,  and  his  whole 


346  PATHOLOGY  OF  MIND.  [chap. 

manner  of  thought,  feeling,  and  conduct  in  regard  to  himself  is 
more  or  less  false.  The  social  fabric  is  held  together  by  moral 
laws ;  but  we  have  here  a  being  who,  by  reason  of  his  insensi- 
bility to  them,  is  practically  outlawed  from  the  social  domain. 

This  disordered  or  literally  distem-pered  condition  of  mind  often- 
times precedes  an  outbreak  of  unquestioned  insanity  in  a  more 
or  less  marked  form  ;  in  other  cases  it  is  a  condition  that  per- 
sists for  a  time  after  the  intellectual  derangement  of  an  attack 
of  madness  has  disappeared.  The  disappearance  of  hallucination 
or  delusion  is  a  sure  sign  of  convalescence  only  when  the  patients " 
return  at  the  same  time  to  their  natural  and  healthy  feelings. 
Some  patients  never  do,  although  they  seem  in  other  respects 
quite  sane :  when  that  is  the  case,  the  experienced  physician 
fears  that  the  persistent  bad  feeling  forebodes  a  recurrence  of 
the  malady. 

When  moral  insanity  exists  by  itself,  and  constitutes  the  disease, 
as  it  may  do,  it  would  be  wrong  to  assume  that  a  particular  vicious 
act  or  crime,  or  even  a  series  of  vicious  acts,  proved  its  exist- 
ence. No  competent  physician  ever  does  that,  although  lawyers 
and  the  general  public  are  apt  to  think  he  does,  and  to  charge 
him  therefore  with  confounding  vice  with  madness.  In  the  pre- 
vious history  of  the  patient  there  will  be  evidence  of  a  suificient 
cause  of  disease  having  been  followed  by  an  entire  change  of 
manner,  feeling,  and  acting;  the  vicious  act  or  crime  will  be 
traceable  through  a  chain  of  symptoms  to  disease  as  cause,  as 
the  acts  of  the  sane  man  are  traced  to  or  deduced  from  his 
desires  and  motives.  '*  There  is  often,"  says  Dr.  Prichard,  who 
first  called  special  attention  to  this  form  of  mental  derangement, 
"  a  strong  hereditary  tendency  to  insanity ;  the  individual  has 
previously  suffered  from  an  attack  of  madness  of  a  decided 
character;  there  has  been  some  great  moral  shock,  as  a  loss  of 
fortune ;  or  there  has  been  some  severe  physical  shock,  as  an 
attack  of  paralysis  or  epilepsy,  or  some  febrile  or  inflammatory 
disorder,  which  has  produced  a  perceptible  change  in  the  habit- 
ual state  of  the  constitution.  In  all  these  cases  there  has  been 
an  alteration  in  the  temper  and  habits."  ^ 

1  A  Treatise  on  Insanity  and  oilier  Disorders  of  the  Mind.  By  J.  0. 
Prichard,  M.D. 


VII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  347 

When  called  upon  to  give  an  opinion  touching  a  particular 
case  of  suspected  moral  insanity,  it  is  well  to  bear  in  mind  that 
the  individual  is  a  social  element,  and  to  take  account  there- 
fore of  his  social  relations.  That  which  would  not  be  offensive 
or  unnatural  in  a  person  belonging  to  the  lowest  strata  of  society 
— certainly  nowise  inconsistent  with  his  relations  there — would 
be  most  offensive  and  unnatural  in  one  holding  a  good  position 
in  society,  and  entirely  inconsistent  with  his  relations  in  it : 
words  which,  used  in  the  latter  case,  would  betoken  grave  mental 
disorder,  may  be  familiar  terms  of  address  amongst  the  lowest 
classes.  There  would  be  nothinfr  stran£re  in  an  Irish  labourer 
ffoino:  about  the  streets  without  his  coat,  or  in  his  usincj  coarse 

DO  '  O 

language  to  his  wife ;  but  if  a  grave  and  reverend  bishop  were  to 
walk  about  the  town  in  his  shirt-sleeves  and  to  use  to  his  wife 
such  language  as  the  labourer  uses  habitually,  there  would  be 
good  cause  to  suspect  that  his  mind  was  deranged.  Between 
individuals,  as  elements  in  the  social  organism,  there  is  in  this 
regard  a  difference  not  unlike  that  which  there  is  between  the 
different  kinds  of  organic  elements  in  the  bodily  organism,  which 
have  more  complex  and  refined  relations  as  they  rise  in  histo- 
logical dignity.  As  it  is  chiefly  in  the  degeneration  of  the  social 
sentiments  that  the  symptoms  of  moral  insanity  manifest  them- 
selves, it  is  plain  that  the  most  typical  forms  of  the  disease  can 
be  met  with  only  in  those  persons  who  have  had  some  social 
cultivation. 

The  following  cases,  which  are  samples  of  many  others  that 
have  come  under  my  observation,  may  serve  to  illustrate  the 
character  of  this  sort  of  mental  derangement : — 

A  single  lady,  aged  thirty-eight,  was  the  only  child  of  indul- 
gent parents  who  were  in  a  good  social  position  and  wealthy. 
Her  father  was  harmlessly  insane,  nearly  imbecile,  and  it  was 
necessary,  after  every  means  of  controlling  her  at  home  had  been 
tried  in  vain,  to  send  her  to  an  asylum.  She  was  given  over 
to  drink  when  she  could  get  spirituous  liquors  of  any  sort,  and 
would  bribe  the  servants  or  any  one  else  she  could  bribe  to  buy 
them  for  her ;  nor  was  she  capable  of  any  self-restraint  in  other 
regards,  making  no  scruple  to  indulge  whatever  passion  she 
found  means  of  indulging.     When  excited   she  was  extremely 


348  PATHOLOGY  OF  MIND.  [chap. 

violent  iu  conduct,  and  on  more  tlian  one  occasion  threatened 
her  father's  life  with  a  pistol.  When  she  could  not  get  spirits, 
she  was  abusive,  mischievous,  quarrelsome,  full  of  complaints 
of  the  injustice  done  to  her,  and  truly  intolerable.  She  had  not 
the  least  appreciation  of  truth,  saying  whatever  she  thought 
would  answer  her  purpose  best  at  the  moment ;  albeit  the  lie 
was  gross  and  palpable  at  the  time,  or  must  plainly  be  detected 
instantly.  In  the  asylum  she  was  the  cause  of  endless  disturb- 
ances ;  she  made  continual  complaints  against  the  attendants, 
ingeniously  perverting  and  exaggerating  real  facts  so  as  to  make 
of  them  monstrous  iniquities,  did  the  most  mischievous  things 
for  the  sole  purpose  of  giving  trouble  and  annoyance  to  the  ser- 
vants, and  was  delighted  with  her  success  ;  sometimes  she  would 
refuse  to  take  her  food,  and  at  the  same  time  would  bribe  the 
attendants  to  secrete  it  for  her  so  that  she  might  take  it  with- 
out any  one  else  knowing.  Eemoved  from  the  asylum,  partly 
in  consequence  of  her  manifold  complaints,  she  w^as  tried  at 
home  unsuccessfully,  then  sent  back  to  the  asylum,  where  she 
went  on  just  as  before,  was  removed  again  after  a  time,  sent 
to  a  different  asylum,  taken  away  from  that,  and  sent  again  to 
another ;  indeed  her  wanderings  were  many,  and  she  was  the 
hopeless  patient  of  every  doctor  wlio  had  the  misfortune  to 
have  anything  to  do  with  her. 

Another  single  lady,  set.  forty-five,  was  a  cousin  of  the  above 
patient,  and  also  of  good  social  position.  Her  appearance  was 
, anything  but  attractive;  she  was  withered,  sallow,  blear-eyed, 
with  an  eminently  unsteady  and  untrustworthy  eye.  So  improper 
and  immoral  was  her  conduct  that  she  was  obliged  to  live  apart 
from  her  family  in  lodgings ;  for  she  seemed  incapable  in  certain 
regards  of  any  control  over  her  propensities.  Whenever  she  was 
able,  she  left  hev  lodgings  to  spend  days  together  at  a  brothel 
with  a  common  fellow,  w^hom  she  supplied  with  money,  frequently 
pawning  her  clothes  for  that  purpose.  When  at  home,  she 
generally  lay  in  bed  for  most  of  the  day.  No  appeal  was  of  any 
avail  to  induce  her  to  alter  her  mode  of  life.  She  was  prone 
to  burn  little  articles,  impulsively  throwing  them  into  the  fire, 
saying  that  she  could  not  help  it,  and  then  cutting  and  pricking 
her  own  flesh  by  way  of  penance.     Now  and  then  she  would  all 


VII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  349 

of  a  sudden  pirouette  on  one  leg,  and  throw  her  arms  about ; 
and,  with  like  sudden  impulsiveness,  would  not  nnfrequently 
break  a  pane  of  glass.  When  reasoned  or  remonstrated  with 
about  her  foolish  tricks,  she  professed  to  feel  them  to  be  very 
absurd,  expressed  great  regret,  and  talked  with  exceeding  plausi- 
bility about  them,  as  though  she  was  not  responsible  for  them, 
but  was  an  angel  in  difliculties  which  she  could  not  overcome. 
It  was  of  no  use  whatever  speaking  earnestly  with  her,  since  she 
admitted  her  folly  to  a  greater  extent  than  accusation  painted  it, 
and  spoke  of  it  with  the  resigned  air  of  an  innocent  victim. 
Her  habits  were  unwomanly  and  often  offensive.  The  more 
sensible  of  the  other  patients  amongst  whom  she  was,  used  to 
get  very  angry  with  her,  because  they  thought  that  she  could 

behave  better  if  she  would.      "  One  can  bear  with  Miss , 

because,  poor  girl,  she  does  not  know  what  she  does,  and  cannot 

help  it ;  but  Miss knows  quite  well  what  she  is  about,  and 

I  am  quite  sure  she  can  help  it  if  she  likes,"  was  the  style  of 
complaint  made  against  her.  There  could  be  no  doubt  that 
she  did  know  perfectly  well  what  she  was  about,  but  her  un- 
conscious vicious  nature,  ever  prompting,  surprised  and  over- 
powered conscious  reflection,  which  was  only  occasional. 

It  is  quite  certain  that  these  women,  so  lost  to  all  sense  of 
the  obligations  and  responsibilities  of  their  position,  could  not 
restrain  their  immoral  extravagances  and  vicious  acts  for  any 
length  of  time ;  punishment  had  no  effect,  except  in  so  far  as 
it  was  a  restraint  for  the  time  being.  They  knew  quite  well  the 
difference  between  right  and  wrong,  but  no  motive  could  be 
roused  in  their  minds  to  induce  them  to  pursue  the  right  and 
eschew  the  wrong ;  their  conduct  revealed  the  tyranny  of  a 
vicious  organisation,  whose  natural  affinities  were  evil  wards  ; 
the  world's  wrong  was  their  right.  Naturally,  therefore,  such 
patients  feel  no  shame,  regret,  nor  remorse  for  their  conduct, 
however  flagrantly  unbecoming  and  immoral  it  may  be,  never 
think  that  they  are  to  blame,  and  consider  themselves  ill-treated 
by  their  relatives  when  they  are  interfered  with.  They  cannot 
be  fitted  for  social  intercourse.  Friends  may  remonstrate,  en- 
treat, and  blame,  and  punishment  may  be  allowed  to  take  its 
course,  but  in  the   end  both  friends  and  all  who  know  them 


350  PATHOLOGY  OF  MIND.  [chap. 

recognise  the  hopelessness  of  improvement,  and  acknowledge 
that  they  must  be  placed  under  control.  The  moral  agency 
which  shall  turn  them  from  the  errors  of  their  ways  has  not 
been  discovered  ;  in  order  to  do  that  it  would  be  necessary  that 
they  should  be  literally  born  again  and  made  new  creatures.^ 

It  is  where  hereditary  taint  exists  that  we  meet  with  the  most 
striking  examples  of  this  kind  of  derangement.  There  is  much 
aversion  to  admit  that  an  extreme  hereditary  taint  may  be  as 
certain  a  cause  of  defect  or  disease  of  mind  as  an  actual  injury 
of  the  head ;  and  yet  it  is  the  fact.  It  signifies  some  unknown 
defect  of  nervous  constitution  declaring  itself  in  a  disposition  to 
irregularities  in  the  social  relations  ;  the  acquired  infirmity  of 
the  parent  having  become  the  natural  infirmity  of  the  offspring, 
as  the  acquired  habit  of  the  parent  animal  observably  becomes 
sometimes  the  instinct  of  the  offspring.  If  a  person  who  has 
the  nerve  tracts  of  moral  function  naturally  but  little  developed 
in  his  brain  does  nothing  to  strengthen  them  by  moral  exercise, 
but  leads  a  life  in  which  they  are  not  brought  into  habitual 
action,  they  undergo  further  atrophy,  and  his  children  or  his 
children's  children  are  likely  to  be  born  with  them  in  such  a 
state  of  defect  that  they  cannot  be  developed  by  exercise,  are 
incapable  of  function,  mark  a  moral  imbecility.  I  do  not  say 
that  a  deficiency  or  an  absence  of  moral  sensibility  will  be  found 
in  the  parents  in  all  cases  ;  sometimes  it  is  hard  to  say  why  the 
children  should  have  been  so  afflicted  ;  but  as  a  rule  we  shall 
note  some  extremely  suspicious  strain  or  other  peculiarity  of 
disposition  in  one  or  both  of  the  parents,  if  we  do  not  find 
actual  insanity.  One  must  look  to  the  fact  that  the  parent  who 
fosters  eccentricities  of  feeling,  thought,  or  conduct  until  they 
grow  out  of  healthy  relations  with  other  mental  functions,  is 
likely  enough  to  breed  a  child  in  which  the  mental  equilibrium 
is  unstable  in  some  way — an  instability  not  necessarily  showing 
itself  simply  in  an  exaggerated  reproduction  of  the  parental 
peculiarities,  however,  but  perhaps  in  some  other  form  of  de- 
generacy.    Hence  comes  the  impulsive  or  instinctive  character 

^  See  also  the  case  of  Christiana  Edmunds,  who  distributed  poisoned 
sweetmeats  to  the  children  of  Brighton,  as  related  in  Res;ponsihility  in 
Mental  Disease,  and  was  tried  for  murder. 


VII.]  THE  SYMPTO^ilATOLOGY  OF  INSANITY.  351 

of  the  phenomena  of  hereditary  insanity,  the  conduct  being 
frequently  startling,  regardless  of  social  usages,  and  seemingly 
quite  motiveless.  Appeal  calmly  to  his  consciousness,  the  indi- 
vidual may  reason  with  great  intelligence,  and  seem  nowise 
deranged  ;  but  if  he  be  left  to  his  own  devices,  or  placed  under 
conditions  of  excitement,  his  unconscious  life  appears  to  get  the 
mastery,  and  to  drive  him  to  immoral,  extravagant,  and  danger- 
ous acts.  He  perpetrates  some  singular  act  of  eccentricity 
because  all  the  world  will  be  astonished  at  it,  or  even  commits 
a  murder  for  the  sole  purpose  of  being  hanged.  It  is  not  right 
for  a  sound  mind  to  fathom  with  its  line  the  mad  motives  which 
spring  up  in  a  madman's  mind,  nor  is  it  just  to  measure  his 
actions  by  a  standard  based  upon  the  results  of  an  examination 
of  sane  self-consciousness;  only  long  experience  and  careful 
study  of  actual  cases  of  mental  disease  will  suffice  to  give  an 
adequate  notion  of  what  a  madman  really  is. 

When  hereditary  taint  is  not  detectable  in  a  case  of  so-called 
moral  insanity,  it  is  necessary  to  traverse  carefully  the  whole 
physical  and  mental  life  of  the  patient,  by  exact  research  into 
his  previous  history  and  the  closest  examination  of  his  present 
state.  Let  it  be  ascertained  whether  there  has  been  any  pre- 
vious attack  of  insanity ;  since  it  sometimes  happens  that  after 
one  or  two  attacks  of  genuine  melancholia,  from  which  recovery 
has  taken  place,  the  patient  suffers  from  true  moral  insanity, 
which  may  pass  at  last  into  intellectual  disorder  and  dementia. 
The  extremest  example  of  moral  insanity  which  I  ever  saw  was 
in  an  old  man  aged  sixty-nine  who  had  been  in  one  asylum  or 
another  for  the  last  fifteen  years  of  his  life.  He  had  no  little 
intellectual  power,  could  compose  well,  write  tolerable  poetry 
with  much  fluency,  and  was  an  excellent  keeper  of  accounts. 
There  was  no  delusion  of  any  kind,  and  yet  he  was  the  most 
hopeless  and  trying  of  mortals  to  deal  with.  Morally  he  was 
utterly  depraved ;  he  would  steal  and  hide  whatever  he  could, 
and  several  times  made  his  escape  from  the  asylum  with  mar- 
vellous ingenuity.  He  then  pawned  what  he  had  stolen,  and 
begged  and  lied  with  such  plausibility  that  he  deceived  many 
people,  until  he  finally  got  into  the  hands  of  the  police,  or  was 
discovered  in  a  most  wretched  and  dirty  state  in  the  company 


352  PATPIOLOGY  OF  MIND.  [chap. 

uf  the  lowest  mortals  in  the  lowest  part  of  the  town.  In  the 
earlier  part  of  his  insane  career,  which  hegan  when  he  was 
forty-eight  years  old,  he  was  several  times  in  prison  for  stealing. 
In  the  asylum  he  was  a  most  troublesome  patient.  He  could 
make  excellent  suggestions  and  write  out  admirable  rules  for 
its  management,  and  was  very  acute  in  detecting  any  negligence 
or  abuse  on  the  part  of  the  attendants,  when  they  displeased 
him ;  but  he  was  always  on  the  watch  himself  to  evade  the 
regulations  of  the  house,  and,  when  detected,  he  was  most 
abusive,  foul,  and  blasphemous  in  his  language.  He  was  some- 
thing of  an  artist,  and  delighted  to  draw  obscene  pictures  of 
naked  men  and  women,  and  to  exhibit  them  to  other  patients. 
He  could  not  be  trusted  with  female  patients,  for  he  would  have 
attempted  to  take  indecent  liberties  with  the  most  demented 
creature.  In  short,  he  had  no  moral  sense  whatever,  while  all  the 
fault  that  could  be  found  with  his  very  acute  intellect  was  that 
it  was  entirely  engaged  in  the  service  of  his  depravity.  It  might, 
no  doubt,  be  argued  that  he  was  a  desperately  wicked  person, 
and  that  his  proper  place  was  the  prison.  But  the  prison  had 
been  tried  many  times,  and  tried  unsuccessfully.  And  there 
was  another  reason  why  prison-discipline  could  not  rightly  be 
permitted  to  supersede  asylum-treatment.  At  long  intervals, 
sometimes  of  two  years,  this  patient  became  profoundly  melan- 
cholic for  two  or  three  months,  refused  to  take  food,  and  was  as 
plainly  insane  as  any  patient  in  the  asylum.  It  was  in  an  attack 
of  this  sort  also  that  his  disease  first  began. 

There  is,  in  fact,  a  class  of  cases  in  which  a  state  of  deep 
genuine  melancholia  alternates  with  a  state  of  mental  excitement 
the  symptoms  of  which  are  principally  those  of  moral  insanity. 
In  some  cases  the  intellect  may  so  far  share  in  the  derangement 
as  to  enable  us  to  call  the  excited  phase  true  mania,  but  in 
others  it  is  so  little  deranged  that  we  certainly  cannot  speak  of 
anything  more  than  moral  mania.  The  patient  displays  an 
excitement  which  is  very  like  that  of  intoxication,  and  an  ex- 
traordinary sense  of  buoyant  happiness:  though  modest  and 
reserved  naturally,  talks  incessantly  and  addresses  familiarly 
persons  whom  he  would  not  have  thought  of  addressing  when  in 
his  natural  state ;  prudent  and  careful  in  business,' he  now  spends 


VII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  353 

money  recklessly  and  enters  into  unaccustomed  speculations ;  of 
grave  and  sober  demeanour,  he  disregards  conventional  proprieties 
and  even  moral  restraints ;  he  listens  to  no  advice  nor  remon- 
strance, and  will  not  brook  the  least  interference ;  his  whole 
character  is  changed  and  his  conduct  entirely  at  variance  with 
the  habits  of  his  natural  life.  Neither  delusion  nor  incoherence 
goes  along  with  this  excitement  and  moral  perversion ;  all  the 
disorder  of  understanding^  which  there  is  beinj?  shown  in  the 
incapacity  of  the  patient  to  understand  how  unlike  himself  he 
is  in  his  feelings  and  conduct.  After  lasting  perhaps  for  months 
the  state  of  excitement  passes  away  and  is  followed  by  deep  and 
genuine  melancholy.  In  one  case  of  the  kind  that  I  saw  the 
change  from  the  one  state  to  the  other  used  to  take  place 
suddenly  and  completely. 

In  other  cases  of  moral  alienation  there  has  been  more  or 
less  congenital  moral  defect  or  moral  imbecility  from  the  first ; 
maniacal  exacerbations  of  positive  moral  insanity  occurring  per- 
haps at  puberty,  perhaps  at  the  menstrual  periods,  perhaps  after 
severe  disappointment.  Again,  moral  insanity  may  come  on  after 
acute  fevers,  after  injury  to  the  head,  after  some  form  of  organic 
brain  disease ;  in  some  cases  it  is  the  first  stage  of  mental  de- 
generation consequent  on  self-abuse,  lasting  as  such  for  some  time 
before  the  intellect  shows  any  signs  of  being  directly  damaged  ; 
now  and  then  it  occurs  in  consequence  of  a  severe  moral  shock 
as  the  forerunner  of  a  genuine  attack  of  marked  insanity ;  and 
it  not  unfrequently  precedes  general  paralysis.  But  the  disease 
with  which  it  is  most  commonly  found  in  conjunction  is  epi- 
lepsy. I  have  more  than  once  adverted  to  the  extreme  change 
in  moral  character  in  some  epileptics  which  precedes  and  fore- 
bodes the  convulsions,  when  they  become  sullen,  moody,  sus- 
picious, morosely  melancholic ;  in  others,  however,  the  moral 
change  is  of  an  opposite  and  elated  kind — they  are  animated, 
loquacious,  active,  borne  up  with  an  exalted  feeling  of  physical 
and  moral  well-being,  and  eager  to  undertake  anything.  I  may 
go  on  to  point  out  that  attacks  of  moral  alienation,  of  variable 
duration  and  of  periodical  recurrence,  sometimes  come  on 
regularly  for  months,  and  seem  quite  inexplicable  until  the 
characteristic  convulsions  make  their  appearance,  proving  them 


354  'PATHOLOGY  OF  MIND.  [chap. 

to  have  been  a  sort  of  abortive  or  suppressed  epilepsy;  or 
ngain,  tlie  epileptic  convulsions  shall  cease,  and  in  place  of  them 
attacks  of  moral  insanity  with  more  or  less  maniacal  excite- 
ment occur.  There  can  be  no  question  in  the  minds  of  those 
who  have  studied  mental  diseases  that  certain  unaccountable 
criminals  belong  to  the  class  of  epileptics.^ 

Thus  much  concerning  the  group  of  symptoms  which  I  have 
made  into  a  second  variety  of  affective  insanity — Moral  Insanity, 
When  we  look  into  its  antecedent  conditions  we  perceive  them 
to  be  such  as  are  known  to  be  hurtful  to  the  brain  or  to  mark 
disorder  of  it :  the  destruction  of  the  moral  sentiment  is  an 
early  effect  of  such  deterioration  of  the  mental  organisation,  as 
any  one  may  recognise,  if  he  will,  in  the  demoralisation  which 
alcoholic  excesses  and  the  excessive  use  of  opium  notably  pro- 
duce. The  facts  being  what  they  are,  it  is  not  a  little  surprising 
that  people  should  go  on  maintaining  that  the  moral  sense  is 
independent  of  physical  organisation.  All  observation  shows  that 
it  is  as  essentially  dependent  upon  a  physical  basis  as  is  the 
humblest  mental  function  of  man  or  animal.  If  the  evidence 
drawn  from  the  nature  and  causation  of  moral  alienation  were 
insufficient,  the  fact  that  it  is  often  the  immediate  forerunner  of 
the  severest  mental  disease  might  suffice  to  teach  its  true  patho- 
logical interpretation.  When,  therefore,  a  person  in  good  social 
position,  possessed  of  the  feelings  that  belong  to  a  certain  social 
state,  and  hitherto  without  reproach  in  all  the  relations  of  life, 
does,  after  a  cause  known  by  experience  to  be  capable  of  pro- 
ducing every  kind  of  insanity,  suddenly  undergo  a  great  change 
of  character,  lose  all  good  feelings,  and  from  being  truthful, 
temperate  and  chaste,  become  a  shameless  liar,  profligate,  in- 
temperate, and  perhaps  a  thief,  then  it  will  certainly  be  not  an 
act  of  strained  charity,  but  an  act  of  bare  justice,  to  suspect  the 
effects  of  disease.  At  any  rate  it  behoves  us  not  to  be  misled 
in  our  judgment  by  the  evident  existence  in  such  a  patient  of  a 
full  knowledge  of  the  nature  of  his  acts — of  a  consciousness,  in 
fact,  of  right  and  wrong ;  but  to  remember  that  disease  may 

^  Morel,  Uiine  Forme  de  Delire  suite  (Tune  Siir excitation  nerveuse  se  rut- 
tacliant  a  une  Variete  non  encore  dccrit  d Epileiisie :  1860.  J.  Falret,  De 
V Etat  Mentale  d' Einleptiques. 


VII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  355 

weaken  or  abolish  moral  feeling  and  tlie  power  of  volition  with 
out  impairing  consciousness.     Fortified  by  this  just  principle,  we 
shall  be  in  better  case  to  interpret  rightly  the  facts  than  when 
biassed  or  blinded  by  the  opposite  erroneous  principle. 

I  pass  now  from  the  consideration  of  the  symptoms  of  affective 
derangement,  which  exist  alone  in  some  cases  and  in  so  many 
other  cases  go  before  distinct  intellectual  derangement.  By  con- 
sidering them  apart,  as  I  have  done,  before  going  on  to  treat  of 
the  varieties  of  intellectual  alienation,  we  get  a  truer  conception 
of  the  evolution  of  insanity,  and  therefore  a  more  natural  history 
of  morbid  psychology,  than  if  we  were  to  proceed  otherwise. 
Moreover,  there  is  the  practical  gain  of  bringing  into  prominent 
relief  grave  phases  of  mental  derangement  which  oftentimes  fail 
to  obtain  due  attention,  albeit  they  have  certainly  not  been 
overlooked  ;  for  the  Mania  sine  delirio  of  Pinel,  the  Monomanie 
raisonnante  ou  sans  cUlire  of  Esquirol,  the  Monomanie  affective  of 
the  same  author,  and  the  Moral  Insanity  of  Prichard  are  different 
names  that  have  been  used  to  denote  them.  From  a  social  point 
of  view  these  morbid  states  are  more  alarming  than  positive 
intellectual  derangement ;  for  they  mark  a  condition  in  which, 
dangerous  hallucinations  and  impulses  are  apt  to  occur  suddenly, 
and  the  tendency  of  which  is,  feeling-like,  to  express  itself  in 
deeds  rather  than  in  words. 


CHAPTER  VIII. 

THE  SYMPTOMATOLOGY   OF   INSANITY — (continued), 

Melancliolict. 

We  "believe  not,  as  did  the  ancients  when  they  gave  it  its  name, 
that  melancholia  is  caused  by  black  bile  (/ueXa?  xoX??),  but  there 
is  no  doubt  that  the  depression  of  mind  which  oftentimes  goes 
before  a  genuine  attack  of  the  malady  is  very  like  that  mood  of 
gloom  which  a  sluggish,  ill-secreting  liver  occasions ;  when, 
without  any  change  in  external  circumstances,  the  only  change 
being  in  him,  the  person  feels  irritable,  gloomy,  apprehensive, 
suspicious.  The  antecedent  symptoms  of  melancholia  may 
indeed  be  summed  up  concisely  as  lowness  of  spirits,  groundless 
forebodino-s  of  cominoj  evil,  and  brooding  abstraction.  There  is 
much  mental  suffering  during  this  preliminary  stage :  the  in- 
dividual's self-confidence  in  thoroughly  shaken,  and  he  is  in  a 
distressing  state  of  exaggerated  susceptibility;  apprehensive 
vaguely  of  some  calamity  being  about  to  happen  to  him,  and 
fearful  of  hearing  or  reading  of  any  painful  incident  because  it 
makes  a  terrible  impression  upon  his  mind  and  he  dreads  lest 
the  like  may  happen  to  him ;  cannot  go  near  a  railway  engine 
or  a  ptecipice  or  over  a  bridge  lest  the  idea  of  putting  an  end 
to  himself  should  take  possession  of  him  and  overpower  him ; 
if  he  reads  or  hears  mention  of  a  disease  is  in  instant  distress 
for  fear  he  shall  have  it ;  is  afraid  of  doing  something  trivial 
and  innocent  lest  he  should  be  doing  wrong,  conscious  all  the 
while  how  foolish  his  fears  are,  which,  nevertheless,  he  cannot 
shake  off ;  imagines  that  preachers  whom  he  hears  are  preaching 


en.  VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  357 

at  him,  and  books  that  he  reads  write  at  him ;  thinks  of  some 
mistake  or  omission,  real  or  fancied,  that  he  has  made  in  his 
business,  magnifies  it  mightily,  and  torments  himself  continually 
with  remorseful  reflections  thereupon.  He  has  lost  all  estimate 
of  proportion,  and  his  mind  is  fascinated  by  the  very  horror  or 
anguish  which  a  painful  idea,  holding  it  in  its  grasp,  occasions 
him ;  not  because  there  is  OTound  for  the  exae^erated  idea,  but 
simply  because  it  is  of  a  painful  character.  Before  he  fell  into 
jthis  "  nervous  "  condition,  as  he  calls  it,  he  has  had  bad  sleep 
|and  bad  dreams,  and  has  probably  suffered  some  slow  drain  upon 
his  vital  energies,  physical  or  mental, — from  worries  in  business, 
from  pecuniary  anxieties,  from  domestic  troubles,  from  exhaus- 
tion by  illness  or  by  excesses,  and  the  like  ;  but  because  of  the 
sadness  which  is  the  main  feature  of  his  condition  there  is 
always  a  disposition  on  the  part  of  friends  to  look  out  for  grief 
as  a  cause,  and  when  no  cause  of  grief  is  discovered  to  suspect 
or  to  assume  a  secret  cause  thereof. 

This  is  the  common  mode  of  onset  of  melancholia,  but  in 
some  instances  it  has  come  on  very  suddenly,  in  consequence  of 
a  severe  mental  shock,  such  as  the  abrupt  announcement  of  the 
sudden  death  of  one  who  was  very  near  and  dear :  the  person 
has  been  thrown  instantly  into  a  state  of  apathetic  stupor  and 
despair, — a  sort  of  tonic  spasm  of  mental  anguish  w^ith  paralysis 
of  all  other  mental  functions.  I  remember  tlie  case  of  a  gentle- 
man's coachman  who  fell  into  that  state  of  apathetic  melancholy 
which  is  known  as  melancJiolia  cum  stuiwre,  or  melancholia 
attonita,  on  making  the  startling  discovery  of  his  wife  in  the 
act  of  adultery  with  his  master.  More  often,  however,  the 
natural  grief  which  a  sad  bereavement  occasions  passes  by  slow 
degrees  into  a  morbid  depression,  in  which  the  person  accuses 
himself  or  herself  of  imaginary  sins  of  omission  or  commission, 
broods  over  them  continually,  is  full  of  self-reproach,  abandons 
occupations  and  interests,  and  is  at  last  quite  indifferent  to 
family,  to  affairs,  and  to  all  other  urgent  present  claims.  Before 
the  profound  change  of  feeling  took  place  the  patient  has  some- 
times been  distressed  by  a  strange  giddiness  or  numbness  or  other 
indescribable  sensation  in  the  head,  or  has  perhaps  felt  as  if 
something  had  suddenly  cracked  there. 


358  PATHOLOGY  OF  MIND.  [chap. 

At  the  begininng  of  melancholia  in  most  cases,  and  through- 
out the  disease  in  some  cases,  there  is  no  definite  delusion ; 
the   person   is   simply    morbidly    melancholic,   suffering   from 
melancholia  sim'plex  or  melancholia  sine  delirio,  as  this  condition 
of   affective  disorder  has  been   called.     But  he  is  profoundly 
changed  notwithstanding  :   his  feelings  regarding  persons  and 
events  are  strangely  perverted,  so  that  impressions  which  would 
naturally  be   agreeable  are  painful,  and  the  attentions  of  his 
relatives  occasion  irritation  or  actual  distress ;  he  has  no  interest 
in  his  family  or  in  his  affairs,  feels  as  if  a  cloud  had  settled 
upon  him,  or  a  veil  had  been  let  down  betw^een  him  and  them, 
since  things  seem  not  real,  as  formerly,  and  it  appears  to  him 
that  he  moves  about  in  a  sort  of  dream  ;  he  shuns  society,  which 
is  distressing  to  him,  cares  not  to  do  any  w^ork,  neglects  his 
personal   appearance,   sinks   into  inactive  brooding,  and  ends, 
perhaps,  if  permitted,  by  lying  in  bed  all  day.     All  this  while 
he  is  quite  conscious  of  his  unnatural  state,  and  perhaps  bursts 
into  tears  as  he  bewails  it ;  he  torments  himself  with  reproaches 
because  he  has  lost  all  natural  affection ;  he  would  give  any- 
thing in  the  world  to  be  himself  again,  and  cannot  conceive  why 
he  is  so  miserably  changed  from  what  he  was.     After  a  time, 
commonly  by  degrees,  but  it  may  be  suddenly,  an  overwhelming 
idea  takes  form  in  his  mind  that  he  is  ruined  in  business,  or  that 
he  has  been  guilty  of  some  crime,  or  that  he  has  committed 
"  the  unpardonable  sin,"  or  that  he  is  a  burden  upon  his  family 
and  ought  to  rid  them  of  it  by  suicide;  the  vast  and  vague 
feeling  of  profound  misery  has  taken  form  as  a  concrete  idea  of 
wrong-doing — has  condensed,  as  it  were,  into  a  definite  delusion 
wdiich  is  the  fitting  expression  of  it.     Sometimes  the  horror  of 
the  condition  is  aggravated  by  the  sudden  and  startling  way  in 
which  the  delusion  has  arisen  and  taken  hold  of  the  mind ; 
instead   of   having  been   gradually  evolved,  as   it   usually  is, 
coming  and  going  several  times,  so  as  to  be  divested  of  some  of 
its  horrors  by  familiarity  before  it  is  mature,  it  has  started  into 
activity  instantly  and  unexpectedly — perhaps  on  the  person's 
awaking  out  of  sleep — entirely  overwhelming  reason  and  produc- 
ing an  alarming  feeling  of  utter  helplessness.    I  have  known  a 
suicidal  and  a  homicidal  idea  to  surprise  and  take  captive  the 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  359 

mind  in  this  sudden  way  and  to  mount  almost  instantly  to  tlie 
convulsive  energy  of  a  scarcely  controllable  impulse  ;  the  very 
suddenness  and  vividness  of  the  revolting  idea  exciting  such  a 
paralysing  horror  as  helped  to  fix  it  in  the  mind. 

The  apparently  spontaneous  origin  of  the  morbid  idea  is 
another  reason  why  it  is  accepted  so  unreservedly  by  the  patient, 
who  feels  himself  unable  to  give  any  account  of  it,  or  to  offer 
any  resistance  to  it.  Had  it  come  by  the  accustomed  paths  of 
association  its  origin  might  have  been  partially  traced,  its  rela- 
tions noted,  ite  validity  weighed  by  comparison  and  reflection ; 
but  coming,  as  it  did,  unexpectedly,  fully  formed,  independently, 
without  any  discoverable  relations  to  external  impressions  or 
to  other  ideas,  it  could  not  be  tested  by  comparison,  and  might 
well  seem  to  .  be  the  suggestion  of  an  evil  spirit,  or  otherwise  of 
supernatural  origin.  Certainly  it  cannot  be  wondered  at  that  a 
person  should  lose  all  self-confidence  and  be  paralysed  by  a 
feeling  of  extraordinary  helplessness  who  finds  his  mind  playing 
him  such  alarming  tricks.  But  it  is  not  to  be  supposed  that  the 
idea  has  really  arisen,  or  that  the  ideas  of  insanity  ever  arise, 
spontaneously ;  we  may  not  know  the  secret  chords  by  which 
they  have  been  made  to  vibrate,  but  we  are  none  the  less  sure 
that  they  have  had  their  causes  and  their  laws  of  morbid  growth. 
As  in  dreams,  other  causes  than  normal  impressions  and  habitual 
associations  must  be  sought.  There  is,  first,  a  possible  organic 
suggestion  coming  from  a  particular  organ  of  the  body  in  con- 
sequence of  the  special  sympathies  which  the  brain  has  with  the 
different  organs;  secondly,  there  is  that  constant  unconscious 
mental  operation — more  active  perhaps  when  the  brain  is  in  an 
abnormal  state — whereby  the  revival  of  latent  ideas  and  feelings 
frequently  takes  place  without  our  being  able  to  give  any  account 
of  it ;  thirdly,  impressions  from  without,  which  seem  so  trivial 
as  to  be  hardly  noticed  at  the  time,  may  still  have  their  effects 
upon  the  mind,  and,  when  the  brain  functions  are  disordered  and 
overclouded  by  gloomy  feeling,  may  be  worked  up  into  strange 
morbid  ideas ;  and,  lastly,  an  idea  may  be  excited  sympathetically 
by  another  idea  to  which  it  has  no  apparent  relation,  particularly 
in  a  morbid  brain,  just  as  the  muscular  contraction  of  a  group  of 
muscles  may  notably  be  sympathetically  excited  sometimes  by 


360  PATHOLOGY  OF  MIND.  [chap. 

the  contraction  of  certain  other  muscles  with  which  they  have 
no  normal  functional  connection.  Persons  whose  nerve-centres 
are  constitutionally  unstable  and  mobile  are  most  likely  to  have 
ideas  start  suddenly  into  consciousness  in  this  seemingly  sponta- 
neous and  independent  way. 

For  any  of  these  causes  to  act  with  much  effect  there  must 
be  a  basis  of  disordered  nerve  element  showing  itself  in  that 
depression  or  perversion  of  the  mental  tone  or  mood  which, 
known  as  simple  melancholia,  precedes  the  formation  of  the 
morbid  idea.  The  common  notion  that  the  person  is  wretched 
because  of  the  painful  delusion  is  usually  a  mistake ;  the  latter 
has  been  precipitated,  as  it  were,  out  of  the  vague  feeling  of  un- 
speakable misery  which  is  the  medium  in  which  its  gestation  or 
incubation  has  taken  place  ;  and  it  takes  different  forms  according 
to  the  person's  culture  and  habits  of  thought,  and  according  to 
the  prevailing  social  and  religious  opinions  of  the  time.  Among 
barbarous  nations  now,  as  was  the  case  among  European  nations 
in  the  middle  ages,  witchcraft  is  laid  hold  of  by  the  distempered 
mind  as  the  cause  of  its  woes ;  at  the  present  day  in  European 
countries  the  fear  of  being  pursued  by  the  police  for  some  crime 
has  dispossessed  and  superseded  the  delusion  of  persecution  by 
witchcraft.  The  conviction  of  having  committed  the  unpardon- 
able sin,  and  of  having  incurred  in  consequence  the  doom  of 
eternal  damnation,  has  been  a  common  delusion  of  melancholies 
since  the  disciples  of  Christ  introduced  that  doctrine  to  man- 
kind ;  but  an  ancient  Greek  who  was  suffering  from  the  same 
form  of  disease  could  not  have  had  that  delusion :  he  would 
have  imagined  himself,  Orestes-like,  to  be  pursued  by  the  Euries. 
In  some  instances  it  is  plain  that  the  delusion  which  the  patient 
believes  to  be  the  cause  of  his  gloom  is  ludicrously  dispropor- 
tionate to  the  extreme  mental  anguish  evinced,  and  quite  in- 
adequate to  explain  it :  a  trivial  act  is  thought  to  have  been  a 
sin  or  a  crime  charged  with  consequences  of  endless  woe.  One 
person  who  was  under  my  care  asserted  that  his  great  afHiction 
was  owing  to  his  having  drunk  a  glass  of  beer  which  he  ought 
not  to  have  done,  and  another  was  lost  for  ever  because  on  one 
occasion  he  had  muttered  a  curse  when  he  ought  to  have  uttered 
a  prayer.     With  him  who  believes  that  his  soul  is  lost,  it  is  not 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  3G1 

the  delusion  which  is  the  fundamental  evil  and  occasions  his 
despair,  but  tlie  affective  derangement  out  of  which  the  con- 
gruous delusion  grows ;  he  thinks  he  has  got  his  adequate 
explanation,  whereas  he  has  got  no  definite  idea  in  his  mind 
at  all,  but  is  content  Avith  a  form  of  w^ords,  or  at  most  with  a 
vague  notion  of  terrible  sin  and  terrible  punishment,  without 
ever  attempting  to  apprehend  sincerely  and  clearly  what  he 
thinlvs  he  believes.  The  finite  cannot  possibly  form  a  definite 
idea  of  the  infinite  or  eternal,  which  so-called  idea  must  always 
be  really  a  negation  or  imbecility  of  thought;  and  the  insane 
delusion  of  eternal  damnation  is  no  more  than  the  vague  and 
futile  attempt  to  interpret  an  utterable  feeling  of  misery — a 
feeling  by  which  it  is  nourished  and  strengthened,  in  accordance 
with  the  law  that  any  passion,  sane  or  insane,  calls  up  and 
intensifies  ideas  that  are  conejruous  with  it. 

Some  melancholies  are  in  a  state  of  panic  fear  without 
knowing  what  they  fear,  and  exhibit  an  excessive  susceptibility 
to  every  kind  of  impression:  whatever  is  proposed,  said,  or 
done  causes  acute  alarm  and  apprehension,  expressed  perhaps 
in  such  repeated  exclamations  as,  *'  Oh !  don't  say  that !  don't 
do  that ! "  or  in  actual  shrieks  of  distress  :  the  most  trivial 
thing,  the  opening  of  a  window  or  a  door,  occasions  exaggerated 
protestations  ;  they  resist  being  w^ashed,  dressed,  and  undressed, 
and  when  pressed  to  eat  protest  earnestly  that  it  is  too  dreadful, 
and  perhaps  retch  as  though  they  would  be  sick;  they  cannot 
walk  out  of  the  house,  and  are  in  despair  if  forced  to  do  so; 
they  resist  the  simple  and  necessary  offices  of  attention  to  them 
with  an  energy  w^hich  would  suit  more  an  attack  upon  their 
lives,  putting  into  their  resistance  a  great  deal  of  passionate 
self-will.  Their  physiognomy,  words,  and  actions  alike  betray 
the  vague  and  acute  apprehension  which  has  taken  possession 
of  them. 

It  is  worthy  of  note  that  the  mental  suffering  is  oftentimes 
actually  less  when  the  vast  and  undefined  feeling  of  dread  has 
been  condensed  into  a  definite  delusion.  This  accords  with  the 
experience  of  the  sane  mind,  which  ever  suffers  more  from 
uncertain  apprehension  and  from  suspense  which  paralyses  its 
energies,  than  from  knowledge  of  a  certain  evil  to  which  it  can 


362  Px\TIIOLOGY  OF  MIND.  [chap. 

begin  forth  with  to  make  some  sort  of  mental  accommodation. 
The  murderer  notably  sleeps  better  after  he  has  been  sentenced 
to  death  than  he  did  before  his  fate  was  decided.  In  like 
manner  doubts  and  uncertainties  about  coming  to  a  resolution 
on  some  point  often  cause  more  mental  worry  and  distress  than 
the  execution  of  the  resolution  come  to,  however  painful  it  may 
be ;  for  the  very  act  of  resolving  imparts  a  comparative  calmness 
and  repose  to  the  mind  by  systematising  its  energies.  AVhen 
the  vague  morbid  feeling  of  the  melancholic  has  been  embodied 
in  a  fixed  delusion  of  some  kind,  he  is  not  only  less  miserable, 
but,  as  a  rule,  he  is  more  easy  and  safe  to  deal  with  than  when 
his  whole  moral  atmosphere  is  disturbed  ;  for  it  is  in  this  latter 
condition  that  painful  ideas  are  especially  apt  to  spring  up  in 
the  mind,  without  apparent  associations  and  in  a  quite  unfore- 
seen manner,  and  to  become  dangerous  impulses  of  a  suicidal  or 
homicidal  character.  Superficial  observers  comfort  themselves 
with  the  notion  that  the  patient  is  not  mad  because  he  has 
no  delusion,  whereas  he  is  more  dangerously  mad  sometimes 
than  if  he  had  the  most  extravagant  delusions,  since  his  mad- 
ness is  likely  to  show  itself  in  deeds  rather  than  in  thoughts. 

The  following  cases  may  serve  as  ordinary  illustrations  of 
melancholia : — 

A  gentleman,  set.  thirty-six,  married,  had  always  been  of  an 
extremely  religious  character  and  of  exemplary  behaviour. 
After  he  had  been  married  for  about  a  year  his  iUness  began 
with  great  depression  and  with  the  involuntary  appearance  in 
his  mind  of  blasphemous  ideas  in  spite  of  all  his  efforts  to  repel 
them ;  he  was  much  distressed  by  this  state  of  things,  his  gloom 
increased  more  and  more,  and  at  last  he  concluded  that  "he 
had  done  it," — namely,  committed  the  unpardonable  sin.  Here 
were,  first,  a  morbid  affection  of  nerve  element  revealed  in  the 
emotional  depression,  then  an  automatic  and  spasmodic  activity 
of  certain  ideational  tracts  manifest  in  the  involuntary  and 
irrepressible  ideas  that  arose,  and  finally  the  concentration  or 
systematisation  of  the  morbid  action  into  a  definite  delusion. 
The  patient  was  further  very  hypochondriacal,  and  fearful  that 
he  should  die  soon ;  but,  although  his  heart's  action  was  feeble, 
and  his  pulse  remarkably  slow,  there  was  no  evidence  of  organic 


viiL]  THE  SYMPTOMATOLOGY  OF  INSANITY.  3G3 

disease.     The  feebleness  of  cardiac  action  was  due  to  tlie  de- 
pressing effects  of  the  morbid  state  of  the  nerve  centres  upon 
the   orcjanic  functions,  all  wliich  shared  more  or  less  in  the 
prostration.      Apart  from  his  delusions  his  reasoning  powers 
were  nowise  affected  ;  he  was  fully  alive  to  all  business  relations, 
and  could  converse  intelligently  and  even  cheerfully  on  indif- 
ferent matters.     But  the  moment  his  attention  was  no  longer 
diverted   from  his   own   suffering   and  otherwise  engaged,  the 
morbid  idea  returned  in  all  its  force  and  engrossed  conscious- 
ness;  his  countenance  became  overcast,  and  he — ^just  now  so 
cheerful — presented  the  characteristic   dejected  appearance  of 
profound  melancholy.     He  lived,  as  it  were,  two  separate  lives 
— at  one  moment  that  of  a  sound,  reasonable  being,  and  the 
next  moment  that  of  a  morbid  automatic  being ;  he  was  quite 
aware  of    his    afSiction,  and  could  reason   about   it  as  a  man 
might  reason  about  a  peculiarity  of  his  character  or  a  particular 
conformation  of  his  body,  though  he  could  not  be  persuaded  of 
its  true  morbid  nature;  so  soon  as  the  train  of  mental  ideas  and 
feelings  excited  by  external  impressions  was  past,  the  morbid 
train  of  thought  recurred.     He  was  made  so  miserable  by  his 
sufferings  that  he  more  than  once  attempted  suicide.      Herein 
we  have  an  example  of  the  error  of   the  statement   that  the 
monomaniac  reasons  correctly  from  false  premisses ;   believing 
that  he  has  committed  the  unpardonable  sin,  and  that  his  soul 
is  for  ever  lost,  he  does  that  which  may  soonest  precipitate  the 
result  which  he  so  much  dreads.     An  uncle  had  been  similarly 
afflicted,  and  had  died  insane. 

Intelligently  as  this  patient  could  talk,  and  rational  as  he 
seemed,  apart  from  his  delusion,  it  would  not  have  been  correct 
to  have  pronounced  him  perfectly  sensible  under  such  limitation. 
There  was  no  sufficient  reason  in  his  intellectual  disorder  why 
he  should  not  have  gone  on  with  his  business,  but  he  could  not ; 
he  thought  he  was  too  weak  in  body  to  do  so,  whereas  he  was 
too  weak  in  w^ill  to  make  a  sustained  attempt ;  he  could  not 
take  interest  in  that,  in  his  family,  or  in  anything  else  but 
himself ;  every  impression  was  more  or  less  painful  to  him,  his 
whole  manner  of  feeling  being  perverted,  and  he  sought  there- 
fore to  avoid  society,  to  be  alone,  and  to  nurse  his  sorrow.     At 


364  PATHOLOGY  OF  MIND.  [chap. 

times,  too,  his  anguish  increased  to  a  veritable  acute  paroxysm, 
and  then  he  looked  very  helpless  and  insane. 

The  case  which  follows,  very  similar  to  the  foregoing  in 
general  symptoms,  illustrates,  by  an  important  additional  symp- 
tom, a  dangerous  feature  in  some  of  these  cases. 

J.  B.,  set.  fifty-one,  married,  had  made  a  small  fortune  by 
his  own  energies,  and  had  brought  up  a  family  respectably.  He 
was  a  stout,  hard-faced,  big-browed  man,  of  sm^ly  appearance 
and  melancholic  temperament.  Of  the  Wesleyan  persuasion, 
he  had  always  been  very  attentive  to  his  religious  duties ;  in- 
deed, religious  devotion  was  said  to  be  the  cause  of  his  illness, 
which  certainly  began  with  doubts  as  to  his  religious  state.  He 
became  gloomy,  morose,  and  depressed,  and  took  to  his  bed  five 
weeks  previous  to  his  being  sent  to  an  asylum.  He  would  not 
get  up,  however  much  entreated :  why  should  he  ?  He  was 
dying,  and  there  was  no  salvation  for  him,  for  his  soul  was.  lost. 
He  slept  fairly  and  ate  well,  though  he  professed  at  times  that 
he  could  not  eat.  In  the  asylum  he  was  listless,  gloomy,  and 
exceedingly  averse  from  exertion  of  any  kind,  always  main- 
taining that  he  was  dying.  "  It's  of  no  use,  I  tell  you,  doctor, 
asking  me  how  I  am :  you  know  I'm  dying."  Apart  from  the 
delusions  as  to  his  soul  and  his  body,  he  was  intellectually 
rational,  although  his  affective  life  was  much  perverted.  After 
a  month's  residence,  there  was  some  improvement  in  his  state ; 
he  walked  outside  the  grounds  regularly  after  having  been 
forced  to  go  on  the  first  occasion  much  against  his  will ;  he  was 
more  cheerful  too,  and  would  talk  a  little.  It  was  thought  that 
he  was  going  on  very  favourabl3^  One  night,  however,  without 
any  warning,  he  suddenly  started  out  of  his  bed,  rushed  at  a 
window,  through  which  it  would  have  been  thought  impossible 
that  a  man  of  his  size,  or  indeed  of  any  ordinary  size,  could 
have  squeezed  himself,  struggled  through  it,  and  fell  from  a  height 
of  twenty  feet,  fortunately  on  his  feet,  so  that  he  w^as  only 
grievously  shaken.  He  was,  hovvever,  in  a  state  of  fearful 
excitement,  fancying  that  the  world  had  come  to  an  end,  writh- 
ing, and  crying  frantically,  "  Let  me  go,  let  me  go ! "  Like 
sudden  desperate  paroxysms  seized  him  periodically  for  the  next 
three  weeks;  after  which  he  began  to  improve.     He  became 


vm.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  365 

talkative,  cheerful,  and  interested  in  his  family,  though  main- 
taining for  a  time,  for  the  sake  of  consistency  seemingly,  that  he 
was  no  better,  and  only  reading  or  employing  himself  when  he 
thouGjht  that  no  one  was  observincj  him.  In  three  months  more 
he  was  discharged  quite  recovered. 

These  paroxysms  of  anguish  or  panic,  which  are  a  notable 
feature  in  some  cases  of  melancholia — paroxysms  of  melancholic 
panic  they  might  be  called — deserve  careful  notice.  They  often 
come  on  quite  suddenly ;  the  patient  has  perhaps  been  lying 
down  to  rest,  and  after  a  short  period  of  repose,  in  which  he  has 
dozed  or  not,  he  starts  up  in  great  agitation,  his  heart  beating 
tumultuously,  his  senses  distraught,  and  rushes  wildly  to  the 
window  to  throw  himself  out  of  it ;  he  is  overwhelmed  for  the 
time  being,  driven  to  desperation,  and  hardly  knows  what  he 
does ;  the  frenzy  has  all  the  characters  of  a  convulsion  affecting 
the  mental  nerve-centres.  In  some  cases  the  convulsive  panic 
is  preceded  by  an  anomalous  and  alarming  sensation  of  distress 
about  the  region  of  the  stomach  or  of  the  heart,  a  sensation 
which,  appearing  to  rise  thence  to  the  head,  is  accompanied  by 
an  indescribable  terror  and  a  dreadful  feeling  of  helplessness. 
The  condition  is  insupportable,  and  he  feels  that  he  must  go 
mad  or  rush  out  of  the  house  and  do  something  dreadful  to 
himself  or  to  some  one  else ;  no  one  can  conceive  the  terrible 
agony  which  he  underwent,  he  will  say  afterwards ;  and  when 
the  paroxysm  is  past  he  trembles  from  head  to  foot,  is  bathed 
in  perspiration  and  completely  exhausted.  The  whole  affair  is 
suggestive  of  the  onset  of  a  mental  epilepsy,  and  the  deed  of 
violence  that  may  be  done  is  like  that  which  is  done  sometimes 
in  the  transitory  mania  that  occurs  in  connection  with  epilepsy. 
Whether  the  explosion  of  violence  in  such  case  shall  be  directed 
against  the  patient's  own  person  or  against  the  person  of  another 
will  probably  be  determined  in  the  main,  partly  by  his  own 
character,  and  partly  by  the  character  of  his  malady.  If  he 
has  laboured  under  delusions  that  he  was  slandered,  persecuted, 
or  otherwise  injured,  and  has  had  a  hard  task  hitherto  to  with- 
stand the  impulses  to  retaliate  against  his  supposed  enemies,  he 
will  be  most  likely  to  attack  one  or  other  of  them  during  the 
fury  of  his  frantic  panic ;  if  his  delusion,  on  the  other  hand,  be 


36G  PATHOLOGY  OF  MIND.  [chap. 

tliat  he  is  liiinself  a  very  wicked  person  who  ought  no  longer  to 
live,  the  probability  is  that  he  will  do  injury  to  himself.  More- 
over, if  he  is  of  a  self-asserting  temperament,  which  reacts 
passionately  against  opposition,  answering  blow  with  blow, 
meeting  threats  with  defiance,  he  is  more  likely  to  be  homicidal ; 
if  he  is  of  a  self-distrustful  temperament,  which  shrinks  from 
contests,  foregoing  his  own  claims  rather  than  assert  them 
defiantly,  he  is  more  likely  to  be  suicidal.  For  the  same  reason 
a  homicidal  tendency  is  less  likely  to  be  present,  and  if  present, 
less  likely  to  be  dangerous,  in  women  than  in  men,  and  in  old 
and  feeble  persons,  the  self-asserting  energy  of  whose  natures  has 
abated,  than  in  young  and  vigorous  persons. 

It  is  noteworthy,  in  some  cases  of  melancholia,  how  sudden 
and  complete  may  be  the  change  from  the  deepest  anguish  and 
despair  to  a  state  of  temporary  calm  and  sanity ;  indeed  it  is 
not  very  uncommon  to  observe  brief  intervals  of  respite,  like 
momentary  breaks  of  blue  in  an  overcast  sky,  during  wdiich  the 
person  is  himself  again.  One  of  my  patients,  suffering  from 
acute  melancholy,  who  usually  wandered  about  moaning  griev- 
ously, or  sat  weeping  profusely,  and  who  had  made  several 
attempts  upon  her  own  life,  awoke  one  morning  seemingly  quite 
well,  rational,  cheerful,  and  wonderfully  pleased  at  her  recovery, 
remaining  so  for  the  rest  of  that  day.  It  was  evanescent,  for 
next  morning  she  had  entirely  relapsed,  and  it  was  some 
months  before  she  finally  recovered.  And  I  have  met  with  one 
extraordinary  case  in  which  for  a  long  time  there  were  daily 
alternations  of  profound  melancholy  and  complete  lucidity. 
Griesinger  mentions  the  case  of  a  woman  with  melancholia  and 
delusions  as  to  loss  of  property  and  persecution,  who  for  the 
space  of  a  quarter  of  an  hour  was  quite  herself,  and  then 
relapsed.  Such  instances  are  of  interest  in  regard  to  the  patho- 
logy of  the  disease,  as  they  prove  that  there  is  no  serious 
organic  disease  so  far;  the  condition  of  nerve  element  is  a 
modification  which,  whatever  its  nature,  may  quickly  come  and 
quickly  go,  not  unlike,  perhaps,  the  electrotonic  state  that  may 
be  artificially  produced  in  nerve. 

In  conversing  with  patients  so  afflicted  it  is  impossible  to 
avoid  being  surprised   at   the   strange    discord  or  incoherence 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  367 

which  their  mental  character  exhibits,  and  difficult  to  help 
thinking  that  they  could  do  more  to  control  their  morbid  moods 
than  they  do.  Certainly  the  self-control  which  they  w^ill  exer- 
cise for  a  time,  especially  before  strangers,  is  so  great  sometimes 
that  a  short  interview  might  produce  a  very  erroneous  impres- 
sion of  their  real  state;  for  when  alone  or  in  the  company  of 
those  who  are  accustomed  to  be  with  them,  they  will  yell, 
moan,  weep,  and  become  pictures  of  despair.  They  seem  to  be 
double  beings — at  one  time  more  rational  than  insane,  at  another 
time  utterly  insane :  the  two  beings  cannot  be  brought  into 
intimate  intercommunication  and  beneficial  reaction  upon  one 
another,  for  the  persistence  of  the  delusion  implies  the  cutting 
off  of  such  healthy  interaction  :  as  conscious  manifestations 
they  are  independent,  isolated.  One  day  the  sound  being  is  in 
predominant  or  exclusive  action;  another  day,  the  unsound 
being;  on  different  occasions  one  might  say — "JSTow  I  am 
talking  with  the  rational  being;  now  with  the  morbid  being." 
Herein  we  have  the  explanation  of  the  doubt  which  such 
patients  sometimes  have  of  themselves  ;  they  are  not  uniformly 
confident,  and  appear  only  to  haK  believe  in  their  delusion  at 
times,  because  they  are  not  then  under  its  entire  influence: 
their  rational  nature  is  in  predominant  action,  and  they  act  in 
their  relations  as  if  their  delusion  really  was  a  delusion.  It 
would  be  a  mistake,  however,  to  put  reliance  on  such  seeming 
hesitation  on  their  part :  let  the  morbid  feelings  be  stirred  up 
and  the  delusion  excited  into  activity,  all  doubts  vanish,  and  the 
sound  beincr  is  brought  into  dangerous  bonda^^e  to  the  unsound 
being;  and  it  would  certainly  be  unsafe  to  conclude  that  a 
person  who  did  some  deed  of  violence  must  needs  have  known 
what  he  was  doing  at  the  time,  because  he  plainly  knew  very 
well  what  he  was  doimj,  half  an  hour  before. 

The  profound  depression  of  the  mental  tone  which  charac- 
terises melancholia  and  inspires  the  gloomy  delusion  makes 
itself  felt  throughout  the  bodily  functions ;  and  it  will  be  con-  . 
venient  to  consider  its  effects  (a)  upon  sensation,  (h)  upon  the 
processes  of  nutrition  and  secretion,  and  (c)  upon  the  acts  or 
general  conduct  of  the  patient. 

The   general   sensibility   of    the   skin  is    commonly    much 


368  PATHOLOGY  OF  MIND.  [chap. 

affected,  being  either  blunted  or  perverted.  The  diminution 
may  be  general,  no  part  of  tlie  body  showing  its  natural  acute- 
ness  of  feeling,  or  it  may  be  local,  when  there  is  sometimes  a 
complete  loss  of  it.  Hence  it  comes  to  pass  that  melancholies 
oftentimes  inflict  severe  mutilations  and  other  injuries  upon 
themselves  which  they  would  hardly  do  if  their  sensibilities 
were  normal ;  a  delicate  young  lady  who  would  shrink  from 
undergoing  the  least  pain  when  in  health  may  thrust  a  needle 
or  a  pair  of  scissors  into  her  heart  in  order  to  commit  suicide ; 
another  patient  gouges  out  his  eyes  with  his  finger  as  a  pen- 
ance for  his  wickedness  and  in  obedience  to  the  Scriptural 
injunction,  "If  thine  eye  offend  thee,  pluck  it  out;"  a  third 
thrusts  his  hand  into  the  fire  and  holds  it  there  until  it  is 
charred,  or  mutilates  himself  sexually  in  such  a  determined 
way  that  it  is  hard  to  believe  any  one  possessed  of  normal 
sensibility  would  have  the  courage  to  do  it.  In  some  cases  it 
is  plain  that  the  loss  or  lessening  of  sensibility  helps  to  keep 
up,  if  it  does  not  actually  occasion,  the  delusions  in  the  mind. 
Our  sensibilities  are  our  channels  of  communication  with  the 
external  world,  and  we  are  so  constantly  and  habitually  depen- 
dent upon  their  normal  functions,  without  thinking  in  the 
least  of  them,  that  we  do  not  realise,  until  they  fail  us,  how 
much  we  owe  to  the  messages  which  we  receive  by  them  every 
moment  of  our  lives.  A  person  who  has  lost  sensation  in  the 
sole  of  his  foot  feels  as  if  his  foot  were  enlarged  and  heavy  and 
did  not  belong  to  him,  or  can  hardly  be  persuaded  that  some- 
thing cushion-like  has  not  been  interposed  between  it  and  the 
ground ;  in  like  manner,  a  poison  like  aconite,  which  deadens 
or  paralyses  general  sensibility,  produces  a  sensation  of  extra- 
ordinary enlargement  or  weight  of  the  whole  body.  Such  being 
the  experiences  of  the  sound  mind,  it  is  not  difficult  to  conceive 
[that  losses  or  perversions  of  sensation  may  contribute  materi- 
ally to  the  generation  and  the  maintenance  of  delusions  in  the 
unsound  mind ;  they  will  be  worked  up  by  it  into  the  strangest 
products,  as  we  know  sensations  oftentimes  are  in  dreams. 

Perversions  of  sensation  frequently  occasion  great  distress. 
Strange  feelings  of  precordial  discomfort  or  pain  in  some  in- 
stances, disquieting  epigastric  or  abdominal  sensations  in  other 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  369 

instances,  or  anomalous  sensations  in  the  head  and  along  the 
spine,  such  as  dull  pain,  coldness,  pressure,  and  the  like,  keep 
the  patient  in  a  cloud  of  despair  or  in  a  fever  of  apprehension 
about  himself.  A  noteworthy  fact  in  connection  with  these 
strange  sensations,  which  are  seldom  actual  pain,  but  more 
alarming  than  if  they  were  pain,  is  that  when  they  reach  a 
certain  pitch  of  intensity  they  cause  an  indescribable  apprehen- 
sion and  distress,  so  that  the  patient  feels  as  if  the  foundations 
of  his  being  were  giving  way,  and  is  perhaps  driven  to  do  some 
wild  act  of  violence  in  order  to  deliver  himself  from  his  insup- 
portable state.  It  is  probable  that  they  originate  in  a  disorder 
of  those  organic  sensibilities  to  which  the  sympathetic  nervous 
system  ministers,  and  which,  though  we  are  not  directly  con- 
scious of  them  and  have  no  power  over  them,  are  essential 
conditions  of  the  physiological  unity  of  the  organism;  if  this 
be  so,  it  is  no  wonder  that  a  disorder  of  them  which  thrusts 
itself  into  consciousness,  threatening,  as  it  seems  to  do,  a 
physiological!  disintegration,  should  be  accompanied  by  a  com- 
plete loss  of  self-confidence  and  an  extraordinary  display  of 
anxiety  and  helplessness.  It  is  seldom  that  any  actual  disease 
can  be  found  to  account  for  the  disquieting  sensations,  but  they 
are  unquestionably  sometimes  more  distressing,  more  disabling, 
than  the  pain  of  severe  organic  disease.  Let  it  be  noted  that 
the  disorders  of  organic  sensibility  in  insanity  are  of  more  im- 
portance, and  deserve  closer  attention,  than  has  generally  been 
thought  hitherto.  When  a  general  paralytic  patient  alleges  that 
he  has  no  mouth,  no  throat,  no  stomach,  no  intestines,  or  that 
he  is  dying  or  is  dead,  it  is  worth-  inquiry  whether  his  delusion 
is  not  due  to  a  deadening  of  his  organic  sensibilities,  the  per- 
fectness  and  union  of  which  have  so  much  to  do  with  the 
consciousness  of  the  physiological  unity  of  the  organism.  In 
like  manner,  w'hen  the  hypochondriac  complains  unceasingly 
of  the  distressing  anomalous  sensations  in  his  interior,  it  is  a 
question  whether  he  has  not  cultivated  such  a  hyperaesthesia 
of  his  organic  sensibilities  by  constant  attention  to  them  as  to 
be  rendered  sensitive  to  the  functions  of  his  orcjans  or  even 
to  the  passage  of  food  through  the  intestines. 
When  the  melancholia  takes  a  hypocliondriacal  form   as  it 


370  PATHOLOGY  OF  MIND. .  [cnAP. 

notably  does  sometimes,  I  tliink,  in  persons  who  break  down  in 
middle  age  after  sexual  excesses  of  youth  and  early  manhood, 
there  may  be  an  exaggerated  sensibility  to  almost  every  impres- 
sion made  upon  sense — a  sort  of  painful  mental  hypersesthesia. 
They  have  so  nursed  their  sensibilities  that  these  have  become 
their  tyrants.  The  person  cannot  perhaps  enter  a  room  unless 
it  has  been  very  well  aired,  and  at  the  same  time  he  dreads  the 
least  draught  of  air,  or  fears  to  expose  himself  to  the  rays  of 
the  sun ;  he  cannot  read,  he  says,  because  his  eyes  immediately 
suffer,  or  bear  to  hear  much  conversation  for  fear  it  may  pro- 
duce pain  and  confusion  of  head ;  he  is  afraid  of  making  any 
real  exertion  because  of  the  pains  and  exhaustion  which  he 
declares  that  he  feels  if  he  does ;  walks,  perhaps,  as  if  his  body 
were  glass  which  would  be  shivered  by  a  shock;  is  troubled 
about  the  sensations  which  he  has  after  taking  food,  lest  per- 
chance he  has  taken  something  which  disagrees  with  him ;  com- 
plains that  his  mind  is  a  perfect  void,  that  he  has  no  memory, 
and  that  he  cannot  make  the  least  intellectual  exertion.  Ex- 
hausted sexual  sensibilities  and  powers  have  taken  out  of  life 
that  which  was  its  main  aim  and  gratification  and  the  backbone 
of  its  interests ;  there  is  no  capacity  to  feel  and  to  respond  to 
stimuli  of  a  higher  order,  which  have  never  been  cultivated,  and 
continual  attention  to  bodily  sensations  has  exaggerated  them  by 
degrees  until  they  have  become  morbid  and  overpowering.  A 
condition  of  morbid  sensibility  very  like  this  in  many  respects 
is  met  with  sometimes  in  young  women  soon  after  puberty,  or  in 
unmarried  women  at  a  later  period  of  life  who  suffer  from  melan- 
cholia with  hysterical  features.'  Whatever  the  immediately  active 
cause  of  their  state,  it  is  past  all  doubt  that  sexual  feeling  has 
had  something  to  do  with  its  production :  perhaps  it  is  that  an 
ungratified  instinct,  having  not  vicarious  diversion  of  its  ener- 
gies in  a  busy  life  of  work  and  interests,  has  shown  itself  in 
the  increase  of  the  general  sensibilities  of  the  organism,  claiming 
and  obtaining  its  gratification  in  the  fostering  of  them ;  or  it 
may  be  that  an  illicit  indulgence  of  the  instinct  is  at  the  bottom 
of  the  mischief. 

Illusions  and  hallucinations  of  the  special  senses  are  common 
in  melancholia,  and  those  of  hearing  more  common  than  those 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  371 

of  sight.  Why  anditoiy  hallucinations  should  be  the  most 
frequent  in  tliis  as  in  other  forms  of  insanity  is  a  question 
which  has  apparently  not  been  considered  ;  but  the  main 
reason,  perhaps,  is  that  we  do  most  of  our  thinking  by  means 
of  words,  the  thoughts  as  they  arise  being  instantly  translated 
into  their  proper  words ;  consequently,  when  a  morbid  thought 
is  vividly  conceived  and  acts  intensely  upon  the  sensory  centre, 
the  words  into  which  it  is  forthwith  translated  are  heard  as 
actual  sounds  or  voices,  and  tliereupon  attributed,  in  accordance 
with  normal  experience,  to  an  external  cause.  Solitary  habits 
and  brooding  thoughts  would  be  likely  to  favour  this  transfor- 
mation of  thoughts  into  heard  words.  Secondly,  hallucinations  of 
hearing  cannot  be  tested  and  corrected  by  touch,  as  a  perception 
of  sight  can;  we  build  up  our  visual  perceptions  by  the  aid  of 
touch,  so  that  they  become  a  language  which  is  interpreted 
instantly  by  past  experience,  and  we  correct  habitually  the 
inferences  of  sight  by  the  mother-experience  of  touch ;  but  we 
cannot  test  a  voice  by  touch,  and  are  more  disposed,  therefore, 
to  let  it  pass  unchallenged.  Thirdly,  the  suspicious  and  dis- 
trustful nature  of  insanity  comes  in  to  strengthen  the  hold  of 
an  auditory  hallucination,  since  it  operates  to  check  or  with- 
hold that  reliance  upon  the  testimony  of  others  which  every- 
body must  practise  in  matters  of  which  he  cannot  have  personal 
experience ;  it  adds  to  the  person's  confidence  in  his  own 
opinion  at  the  same  time  that  it  takes  from  his  trust  in  the 
authority  of  others.  After  all,  the  last  foundation  of  knowledge 
is  to  feel  and  to  do,  to  be  susceptible  to  external  stimuli  and  to 
make  respondent  actions,  —  in  other  words,  it  is  truly  a  grasp- 
ing or  ai:)pTchension  of  external  nature,  social  and  physical,  as 
the  result  of  close  and  sincere  relations  with  it ;  whosoever, 
therefore,  is  separated  from  his  kind  by  a  barrier  of  distrust, 
being  among  them  but  not  of  them  in  feeling  and  doing,  cannot 
apprehend  truly  concerning  them,  and  is  on  the  way  to  become 
a  morbid  social  element. 

Auditory  hallucinations  will  be  found  to  differ  in  character 
when  they  are  closely  examined ;  and  tliese  differences  will 
throw  some  light  upon  their  mode  of  origin.  Some  patients  are 
much  distressed  by  the  involuntary  upstarting  in  their  minds  of 


372  PATHOLOGY  OF  MIND.  [chap. 

painful  ideas  which  are  often  of  a  hlaspheraous  or  obscene 
nature;  if  tliey  are  of  a  religious  disposition  they  are  the  more 
alarmed  by  what  they  describe  as  dreadfully  wicked  thoughts, 
and  cannot  help  tliinldng  them  proof  that  they  are  given  over 
to  Satan  on  account  of  their  sins.  So  far  there  is  not  actual 
hallucination  :  morbid  ideas  start  up  against  the  will  in  dis- 
ordered mind-centres,  just  as  convulsions  or  spasms  proceed 
from  disordered  motor  centres,  and  are  interpreted  in  accordance 
with  the  person's  habit  of  thought.  The  next  step  in  misinter- 
pretation, however,  is  to  imagine  that  the  wicked  thoughts  are 
the  suggestions  of  others — either  of  evil  spirits  or  of  corporeal 
enemies — who  have  got  possession  of  their  thoughts  in  some 
mysterious  way,  know  everything  that  passes  in  their  minds, 
dictate  what  they  shall  think,  and  reply  to  it  before  it  -is 
distinctly  conceived  by  them :  no  actual  voices  are  heard,  but 
the  conviction  is  that  their  persecutors  have  made  themselves 
masters  of  their  thoughts  by  some  extraordinary  trickery,  and 
direct  them  as  they  please.  It  is  the  only  explanation  which 
they  can  conceive  of  the  origin  of  thoughts  which  are  painful 
and  hateful  to  them,  which  they  feel  strongly  are  not  the 
thoughts  of  their  true  selves,  and  which  certainly  come  to  them 
against  their  will. 

The  next  step  is  that  the  ideas  as  they  arise  are  transformed 
into  words  heard ;  they  strike  upon  the  auditory  ganglia,  become 
actual  hallucinations,  and  are  heard  distinctly  as  the  voices  of 
persons  uttering  them.  In  vain  we  attempt  to  convince  the 
patient  so  afflicted  that  the  thoughts  momentarily  precede  and 
really  cause  the  voices ;  he  hears  them  as  plainly  as  he  hears 
our  words,  and  has  the  same  certitude  of  their  reality ;  and 
he  is  not  expert  introspectionist  enough  to  be  able  to  watch 
his  ideas  and  to  catch  them  at  the  instant  of  their  rise  before 
they  are  transformed  into  sounds.  The  late  Sir  H.  Holland 
mentions  the  case  of  a  gentleman  who  believed  in  and  acted 
upon  illusive  sounds  and  conversations  of  this  kind,  being 
treated  as  deranged  in  consequence,  and  who  after  a  while 
recovered  so  far  as  to  recognise  and  treat  them  as  hallucinations. 
When  he  was  asked  to  explain  how  it  was  that  he  had  come  to 
look  upon  them  in  that  sensible  light,  he  said  that  it  was  partly 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  373 

by  never  discovering  any  person  in  the  places  from  which  the 
voices  seemed  to  come,  but  chiefly  by  finding  himself  able,  on 
trial,  to  suggest  the  words  which  appeared  to  be  uttered  by  some 
one  to  him.  Without  doubt  he  was  already  on  the  way  to 
recovery  from  his  malady  when  he  was  able  to  make  this 
successful  self-examination  and  to  detect  the  tricks  which  his 
mind  was  playing  upon  itself.  In  dreams  a  person  is  similarly 
self-fooled.  The  apt  replies  and  admirable  arguments  of  the 
person  with  whom  the  dreamer  talks  are  of  course  his  own 
replies  and  arguments, — his  own  thoughts  which  he  hears  spoken 
— though  he  is  not  aware  of  it  at  the  time ;  coming  not  by  the 
regular  paths  of  association,  but  in  a  way  quite  independent 
of  wdll  and  consciousness,  they  meet  him  as  strangers  and  are 
ascribed  to  some  one  else  whom  he  sees  and  hears.  The  habitual 
co-ordination  of  thoughts  and  feelings,  which  is  the  basis  of  the 
consciousness  of  personal  identity,  is  suspended  in  sleep,  and  it 
is  only  when  the  normal  co-ordination  is  being  re-established, 
as  was  the  case  with  Sir  H.  Holland's  patient  when  he  was  able 
to  suggest  the  words  which  were  seemingly  uttered  by  another 
person,  or  as  is  the  case  with  the  dreamer  who  is  just  about  to 
awake,  that  he  recovers  his  sense  of  personal  identity  and  begins 
to  suspect  or  to  perceive  the  true  nature  of  the  hallucinations. 

It  is  a  common  observation  that  hallucinations  of  hearing 
abate  or  disappear  for  a  time  with  change  of  scene,  those  who 
have  them  being  most  free  from  them  when  travellino-  from 
place  to  place  :  insulted  by  offensive  remarks  in  one  hotel  or 
town,  they  leave  it  in  consequence,  and  in  the  new  hotel  or  city 
which  they  arrive  at  they  are  free  from  trouble  for  a  day  or  two. 
Then,  however,  the  insults  are  renewed.  Believing  that  they 
have  left  their  persecutors  behind  them,  they  expect  not  to 
hear  them  when  they  reach  the  new  place,  wherefore  their  minds 
are  not  running  on  the  train  of  morbid  thoughts ;  the  diversion 
of  thought  is  further  aided  by  the  interest  of  the  new^  surround- 
ings ;  soon,  however,  this  source  of  interest  is  exhausted,  the 
morbid  habit  of  suspicion  revives,  attracting  and  holding  the 
attention,  the  hallucinations  recur,  and  the  unfortunate  persons 
declare  that  their  enemies  have  followed  them  and  are  at  their 
evil  work  again.     One  gentleman  who  consulted  me  because  of 


374  PATHOLOGY  OF  MIND.  [chap. 

persecutions  of  the  kind  found  Limself  much  relieved  when 
travelling  in  jNorway,  especially  so  in  its  wilder  parts,  where  he 
seldom  met  any  one;  as  soon  as  he  returned  to  populated 
countries  his  afflictions  were  as  bad  as  ever.  Another  gentleman 
could  only  make  life  endurable  by  wandering  from  place  to 
place  day  after  day,  not  staying  more  than  one  night  in  the  same 
hotel ;  when  in  England  he  bought  a  horse  and  gig,  and  drove 
from  town  to  town,  leaving  in  the  morning  the  place  where  he 
had  slept  at  night  and  carrying  food  with  him  which  he  took  by 
the  roadside  or  in  a  field.  He  had  got  into  various  troubles  on 
account  of  his  vagrant  life :  ORce  the  police  had  taken  him  in 
charge  and  locked  him  up  ;  once  he  had  been  brought  before  a 
magistrate  for  cruelty  to  his  horse,  which  had  a  neglected  sore 
on  its  shoulder ;  twice  his  horses,  wearied  of  standing,  had  ruQ 
away  with  his  gig  while  he  was  taking  his  midday  meal  and 
had  done  injury,  the  one  to  itself,  the  other  to  the  conveyance ; 
but  he  had  got  over  that  danger  by  buying  a  London  cab- 
horse,  which  would  stand  still  for  any  length  of  time.  He  had 
tried  most  of  the  best  hotels  in  London,  had  fancied  himself 
persecuted  in  all  of  them,  and  having  had  quarrels  in  con- 
sequence, was  hard  put  to  it  to  go  where  he  would  be  received 
again. 

At  an  early  stage,  before  the  hallucinations  are  fixed,  travel 
in  a  foreign  country,  the  language  of  which  the  patient  does 
not  understand,  may  help  much  to  dispel  them  ;  but  when  they 
are  fixed  and  he  has  ceased  to  have  any  doubt  about  them  he 
sees  threats  and  insults  in  looks  and  gestures,  interprets  in  an 
ill  sense  words  which  he  does  not  understand,  or  hears  reproaches 
uttered  in  his  own  language  which  he  declares  his  persecutors 
understand.  A  gentleman  I  once  saw  who  knew  three  lan- 
guages besides  his  own  was  always  most  persecuted  in  his  own 
language,  very  seldom  in  the  language  which  he  knew  least, 
more  often  in  the  other  foreign  languages  with  which  he  was 
well  acquainted.  And  Esquirol  mentions  the  case  of  a  gentle- 
man who  heard  rexDroaches  in  all  the  languages  of  Europe,  which, 
being  an  accomplished  linguist,  he  understood ;  he  had,  how- 
ever, most  difficulty  in  understanding  those  which  were  made 
in   the  Kussian  language,   which  he  himself  spoke  with  most 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  375 

difficulty  !  "  Tor  tlie  rest,"  he  said,  "  the  language  is  of  no  con- 
sequence ;  one  may  communicate  many  things  by  a  look  or  a 
gesture,  even  when  one  is  a  long  way  from  the  person."  ^ 

The  secondary  production  of  hallucination  through  the  agency 
of  morbid  idea  is  not  the  only  mode  of  production  ;  there  can  be 
no  doubt  that  hallucination  may  originate  directly  in  a  deranged 
sensory  ganglion.  There  are  several  poisons  which,  w^hen  intro- 
duced into  the  blood,  act  through  it  upon  the  nervous  system  to 
excite  distinct  subjective  sensations,  chief  among  them  being 
belladonna,  which  gives  rise  to  very  remarkable  visual  halluci- 
nations ;  in  fevers  again  we  observe  hallucinations  and  illusions, 
the  characters  and  manner  of  origin  of  w^hich  certainly  indicate 
that  they  proceed  immediately  from  disordered  sensory  centres  ; 
and  reasons  have  already  been  brought  forward  to  show  that 
the  hallucinations  which  occur  in  dreams  and  just  before  going 
to  sleep  are  often  provoked  by  internal  affections  of  the  sensory 
organs  or  their  ganglia.  It  is  easy  to  understand  then  that  the 
hallucinations  of  insanity  are  sometimes  excited  directly  in  the 
same  way.  Whenever  an  impression  from  without  is  made 
upon  the  senses,  of  wdiich  the  person  is  distinctly  conscious,  it 
stirs  up  an  idea  of  some  kind ;  naturally  therefore  the  stimula- 
tions of  sense  by  internal  causes  will  similarly  excite  ideas, 
which  may  be  true  or,  more  likely,  untrue  interpretations  of 
them,  A  bad  taste  in  the  mouth  owing  to  disordered  dio-estion 
may  generate  the  hallucination  of  poison  in  the  food ;  a  neu- 
ralgic pain  in  the  face  that  of  torture  by  electricity  or  by  some 
more  mysterious  agency ;  a  bad  smell  the  hallucination  of  poi- 
sonous vapours  diffused  through  the  room ;  and  so  with  the 
other  senses.  Although  the  morbid  sensation  is  truly  the  occa- 
sion of  the  hallucination  in  these  cases,  this  would  never  be 
believed  in  as  denoting  an  objective  reality  and  take  rank  in  the 
mind  as  a  distinct  perception,  without  the  co-operation  of  dis- 
order in  the  higher  centres  of  thought ;  since  were  they  perfectly 
sound  they  could  not  fail  to  correct  the  evidence  of  the  deranged 
sense  and  to  perceive  the  true  nature  of  the  hallucination — as 
was  done  indeed  by  the  celebrated  Mcolai  of  Berlin  and  many 
others  who,  like  him,  suffered  from  hallucinations  of  purely 
1  Dictionnaire  des  Sciences  Medicales,  t.  xvi.  p.  154. 
17 


376  PATHOLOGY  OF  SIIND.  [ohak 

bodily  origin.  In  most  cases  there  is  without  doubt  a  combined 
action,  or,  so  to  speak,  a  conspiracy  of  disordered  thought  and  of 
disordered  sense  in  the  production  of  the  hallucination ;  the 
illusive  sensation  excites  a  morbid  idea,  which  thereupon  plays 
back  upon  the  sensation,  giving  it  a  morbid  interpretation; 
and  we  can  no  more  mark  the  respective  limits  of  the  function 
of  idea  and  of  that  of  sensation  in  the  false  perception,  than  we 
can  mark  their  respective  limits  in  sound  perception.  The 
major  part  of  every  perception,  true  or  false,  is  inference.  It 
may  be  set  down  then  as  established  by  experience :  first,  that 
the  primary  occasion  of  a  hallucination  or  an  illusion  may  be 
either  in  the  subordinate  sensory  ganglia  or  in  the  superordinate 
centres  which  minister  to  ideas :  and,  secondly,  that  although 
sensory  and  ideational  centres  are  commonly  in  an  intimate 
conspiracy  to  produce  it,  yet  they  sometimes  do  not  agree,  the 
one  contradicting  and  correcting  the  other.  Certainly  it  were 
an  excellent  thing  if  a  man  could  always  keep  his  ideas  sound 
when  his  senses  are  disordered,  and  his  senses  sound  when  his 
ideas  are  disordered. 

Hitherto  I  have  dealt  almost  exclusively  with  hallucinations 
of  hearing,  which  are  the  most  frequent  in  mental  derangement, 
but  most  of  what  I  have  said  concerning  them  is  true  of  the 
hallucinations  and  illusions  of  the  other  senses  which  occur. 
The  patient  sometimes  has  hallucinations  of  taste,  his  food  has 
a  poisonous  or  disgusting  taste,  and  he  believes  that  he  is  being 
poisoned  or  being  fed  on  carrion  ;  his  smell  is  disordered,  and  he 
imagines  that  stinking  odours  or  pestilential  vapours  proceed 
from  his  own  body  or  are  diffused  through  his  room  by  his 
persecutors ;  he  has  illusions  of  sight  and  no  longer  recognises 
his  nearest  relations,  believing  them  to  have  been  changed  in 
some  extraordinary  way,  and,  worse  still,  he  sometimes  sees 
them  as  devils  and  resists  violently  the  attentions  which  he 
receives  from  them  as  tortures  which  they  are  inflicting  upon 
him.  I  was  once  consulted  by  an  old  gentleman  who,  perfectly 
intelligent  in  other  respects,  believed  that  offensive  odours 
emanated  from  his  body  to  such  a  degree  as  to  cause  great  dis- 
tress to  all  who  were  brought  near  him  in  his  business,  which 
he  nevertheless  conducted  wath  skill  and  judgment.     So  bad 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  377 

was  this  smell,  lie  declared,  that  the  persons  in  the  next  house 
were  annoyed  by  it  and  he  could  often  hear  them  cough  in 
consequence  ;  that  the  cab-horses  standing  on  the  cabstand  moved 
restlessly  as  he  passed  them;  and  that  those  who  did  business  with 
him  were  obliged  from  time  to  time  to  put  their  handkerchiefs 
to  their  noses,  being  too  polite,  however,  ever  to  say  anything  to 
him  on  the  subject.  To  prevent  the  excessive  accumulation 
of  these  odours  in  one  room,  he  used  to  sleep  for  the  first  part 
of  the  night  on  the  ground-floor  of  his  house,  mounting  higher 
at  a  later  period  of  the  night.  He  was  very  depressed  because 
of  his  sufferings,  took  his  walks  in  solitary  places  where  he 
might  meet  as  few  persons  as  possible,  and  sometimes  felt 
inclined  to  put  an  end  to  them  by  suicide.  All  this  time  his 
partners  in  business  had  not  the  least  notion  that  there  was 
anything  specially  wrong  with  him.  At  the  end  of  several 
months  an  abscess  formed  at  the  lower  part  of  the  sternum,  and 
after  this  had  burst,  discharging  a  large  quantity  of  pus,  he 
recovered  entirely  from  his  delusions.  It  would  seem  that  an 
offensive  smell  of  subjective  origin,  due  probably  to  sotoe  latent 
disease  which  eventually  caused  the  abscess,  was  so  strong  as 
to  overpower  reason  and  to  fix  firmly  in  the  patient's  mind  the 
delusive  conviction  that  everybody  else  smelt  what  he  smelt. 

Let  it  be  noted  with  regard  to  hallucinations  that  they 
sometimes  originate  apparently  as  the  remembered  hallucina- 
tions of  dreams  which  are  taken  to  be  real.  One  lady  whom  I 
saw  had  visions  of  a  person  entering  her  room  in  the  night ;  at 
times  she  was  uncertain  whether  the  occurrence  was  a  dream, 
but  at  other  times  was  positive  that  it  was  real.  If  one  studies 
carefully  the  beginnings  of  hallucinations  it  will  be  found  that 
they  are  oftentimes  first  experienced  in  the  night  or  in  the 
intermediate  stage  between  sleeping  and  waking,  and  afterwards 
only  as  they  gain  strength  get  possession  of  the  mind  in 
the  day. 

The  processes  of  nutrition  and  secretion  are  usually  much 
affected  in  melancholia,  the  depression  of  tone  making  itself 
felt  throughout  them.  Considering  the  profound  depression  and 
extreme  prostration  of  energy  which  are  witnessed  in  some 
instances,  it  is  almost  a  wonder  that  the  organic  life  goes  on  as 


378  PATHOLOGY  OF  MIND.  [chap. 

well  as  it  docs.  The  heart's  action  is  often  much  lowered,  the 
circulation  being  languid,  the  extremities  cold  and  livid,  the  pulse 
slow,  feeble,  and  irregular,  or  actually  intermittent.  It  will  be 
noted  sometimes  that  the  pulse  is  very  irregular  or  actually 
intermittent  during  a  paroxysm  of  melancholic  depression,  and 
that  it  recovers  its  natural  beat  as  the  depression  passes  off. 
The  respiration,  in  sympathy  with  the  heart,  is  slow,  interrupted 
by  frequent  sighs,  and  perhaps  moaning.  The  temperature  of 
the  body  is  lowered.  The  skin  loses  its  freshness,  becoming 
sallow,  dry,  and  harsh,  and  in  this,  as  in  idiocy  and  some  other 
forms  of  insanity,  its  excretions  have  a  disagreeable  odour, 
which  will  hang  about  a  room  in  which  several  patients  have 
been  assembled.  I  doubt  not  that  an  acute  nose  might  be 
trained  to  recognise  insanity  by  its  odour  in  some  instances. 
The  excretions  from  the  bowels  are  sometimes  particularly 
offensive.  Digestion  is  often  deranged,  the  tongue  being  coated 
— like  a  piece  of  chamois  leather  in  a  few  cases  ;  flatulent  eruc- 
tations are  frequent,  and  there  is  sometimes  great  distress  or 
actual  sickness  after  food.  The  patient  does  not  improve  matters 
perhaps  by  his  mode  of  eating,  since  he  is  apt  to  take  food 
hastily  and  indifferently,  without  taking  any  care  to  masticate 
it  properly. 

The  bowels  are  usually  constipated ;  owing  partly  to  defective 
secretions  of  their  lining  membranes,  partly  to  indolent  action 
of  their  toneless  muscles,  and  partly  to  the  obtuse  sensations  of 
the  patient,  and  to  his  want  of  energy  to  attend  to  them.  In 
some  cases  the  urine  is  abundant  in  quantity  and  very  pale  in 
colour ;  in  others  it  is  scanty,  thick,  and  high-coloured ;  these 
differences  betoken,  I  believe,  different  states  of  nutritive  de- 
rangement and  prescribe  different  constitutional  treatment. 
Menstruation  is  commonly  irregular  or  suppressed.  In  a  few 
cases  I  have  known  the  hair  to  turn  quickly  grey  during  an 
attack,  becoming  less  so  again  after  recovery  from  it.  Every- 
thing shows  the  depressing  influence  of  the  gloom  of  mind,  or 
rather  of  the  disordered  nervous  function  which  is  the  condition 
of  the  gloom,  upon  the  organic  life.  There  is  often  great  want 
of  sleep,  at  any  rate  before  the  disease  has  become  chronic, 
but  these  patients  are  apt  to  affirm  that  they  have  not  slept  a 


VIII.]  THE  SYxMPTOMATOLOGY  OF  INSANITY.  379 

wink  when  they  have  slept  tolerably  well ;  the  sleep  having 
been  imperfect,  or  disturbed  by  vivid  and  painful  dreams,  they 
feel  unrefreshed  and  tired  when  they  awake,  and  can  hardly  say 
whether  they  have  slept  or  not.  The  early  morning  is  usually 
the  worst  time  with  melancholies,  who  become  more  cheerfid. 
towards  the  evening,  when  they  may  for  a  short  time  be  almost 
themselves.  This  may  be  owing  to  the  diminution  of  the  blood 
in  the  brain  during  sleep  and  to  the  delay  or  difficulty  of  re- 
storing an  active  supply  because  of  the  enfeebled  heart ;  or  it 
may  be  simply  the  despair  of  a  mind  undistracted  by  external 
impressions  and  concentrated  upon  its  gloomy  thoughts,  on 
awakening  anew  to  them  from  the  blessed  repose  of  a  temporary 
oblivion.  In  some  cases,  on  the  other  hand,  the  terror  and  dis- 
tress are  greatest  at  night,  amounting  perhaps  to  a  veritable  panic 
when  the  time  comes  to  retire  to  bed.  It  is  remarkable  too 
that  a  good  night  of  sleep  is  sometimes  followed  by  a  worse  state 
of  things  than  is  a  sleepless  night:  the  sleep  has  seemingly 
restored  more  sensibility  to  feel  the  sufferings  and  more  energy 
to  express  the  distress  in  conduct. 

Eefusal  of  food  is  common  and  is  sometimes  very  persistent : 
it  may  be  owing  to  delusions — such  as  that  the  food  is  poisoned, 
that  the  throat  or  the  bowel  is  closed  and  will  not  let  it  pass — 
whence  violent  exclamations  perhaps  against  the  cruelty  of  being 
obliged  to  take  it — or  that  the  patient  is  unworthy  to  live  and 
ought  to  die  of  starvation ;  it  is  sometimes  the  mere  outcome  of 
a  morbidly  perverse  humour  to  resist  everything  that  ought  to  be 
done,  and  of  a  crossgrained  pleasure  in  doing  the  contrary ;  and 
it  is  at  other  times,  in  great  part  or  in  whole,  the  expression  of 
a  want  of  appetite  and  of  the  general  sluggishness  of  nutrition. 
Even  when  the  refusal  is  associated  with  decided  delusions  which 
appear  to  have  instigated  it,  both  it  and  the  delusions  will  be 
aggravated,  the  latter  being  more  active  and  the  refusal  more 
determined,  whenever  the  tongue  is  coated  and  the  digestion  out 
of  order.  I  once  had  under  my  care  a  lady  who  refused  food 
entirely  for  a  week  at  the  beginning  of  her  illness  under  the 
delusion  that  her  throat  was  closed  up,  the  refusal  being  over- 
come only  by  the  use  of  the  stomach-pump ;  for  some  time  after- 
wards in  her  case  the  old  delusion,  at  low-water  mark  usually, 


380  PATHOLOGY  OF  MIND.  [chap. 

became  full  and  active,  and  the  disposition  to  refuse  food  re- 
turned, whenever  the  digestion  was  disordered. 

The  movements  and  conduct  of  the  melancholic  share  the 
languor  and  accord  with  the  character  of  his  other  functions. 
He  is  commonly  averse  from  exertion  of  any  kind,  slow,  languid, 
and  heavy  in  his  movements,  and  disposed  to  sit,  lie,  or  stand  for 
any  length  of  time  without  caring  to  move  until  he  is  prevailed 
upon  by  much  importunity  or  by  actual  force  to  do  so.  He  has 
no  interest  in  what  is  going  on,  and  neither  desire  nor  energy  to 
take  part  in  it.  In  that  extreme  form  of  depression  which  I 
have  already  spoken  of  as  melancJiolia  attonita,  he  sits,  lies,  or 
stands  almost  motionless  in  one  position,  not  moving,  even 
though  it  be  a  constrained  one ;  he  allows  flies  to  settle  on  his 
face  without  brushing  them  away ;  he  must  be  moved  or  carried 
from  place  to  place,  must  have  his  food  put  into  his  mouth,  and 
must  be  cared  for  by  others  in  every  respect ;  his  muscles  are  gene- 
rally relaxed,  or  some  of  them — those  of  the  arm,  for  example — 
are  fixed  in  a  quasi-cataleptic  rigidity  ;  he  is  in  a  waking  night- 
mare, so  to  speak,  or  like  a  person  paralysed  by  a  great  fright 
who  cannot  stir  a  foot,  and  he  cannot  realise  the  true  nature  of 
his  surroundings  nor  command  the  volition  to  exert  himself  in  the 
least.  The  fact  is  that  his  mind  is  fixed  in  the  cataleptic  rigidity 
of  some  terrible  delusion  :  he  believes  himself  to  be  the  cause  of 
all  the  horrors  in  the  world,  and  to  be  a  wretch  too  vile  and 
loathsome  to  be  touched  by  any  human  being  ;  or  he  imagines 
that  he  is  surrounded  by  flames  of  fire,  or  that  he  is  standing  on 
the  edge  of  a  vast  sea  of  fire  or  of  blood  and  will  be  precipitated 
headlong  into  it  if  he  moves  a  step  forward ;  or  he  has  the 
delusion  that  he  is  actually  in  hell,  sees  devils  about  him,  and 
hears  shrieks  of  sufferers  ringing  in  his  ears.  He  is  not  always, 
however,  so  unconscious  of  external  realities  as  he  appears ;  if 
his  nose  or  his  feet  be  tickled  with  a  feather,  or  if  his  skin  be 
pinched  or  pricked,  he  will  sometimes  show  by  a  grunt  or  a 
groan,  or  by  a  shrinking  movement,  that  he  feels  pain  ;  and 
when  he  comes  out  of  his  trance-like  state  he  may  prove  that  he 
w^as  a  great  deal  more  keenly  alive  to  what  was  going  on  than  he 
was  thought  to  be,  by  remembering  exactly  most  of  what  was 
said  or  done  in  his  presence.     Many  times  I  saw  a  gentleman 


viii.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  381 

who  lay  in  this  state  of  suspended  mental  animation  for  upwards 
of  two  years,  being  carried  from  bed  to  couch  and  back  again 
each  day,  never  speaking  a  word  all  that  time,  taking  no  food 
-except  fluid  nourishment  which  was  forced  into  his  mouth, 
altogether  inattentive  to  the  calls  of  nature ;  at  the  end  of  this 
long  period,  when  he  was  in  an  extremely  emaciated  and  feeble 
state,  he  startled  his  attendant  one  day  by  asking  him  in  a  weak 
whisper  for  a  cup  of  tea,  which  he  drank  willingly;  thence- 
forward he  was  perfectly  rational,  and  w^ent  on  rapidly  to  entire 
recovery  of  bodily  strength.  He  had  believed  that  he  was  in 
hell,  and  that  those  who  attended  on  him  were  devils  who  were 
mocking  and  tormenting  him ;  that  he  was  a  horribly  disgusting 
object  and  must  not  be  approached  or  touched ;  and  that  he  could 
not  possibly  or  must  not  for  the  life  of  him  make  the  least  sign 
or  exertion.  But  what  was  very  remarkable  was  that  when  no  one 
was  in  his  room,  and  he  believed  that  he  was  entirely  unobserved, 
he  would  assume  a  more  comfortable  position  as  he  lay,  or 
^vould  actually  raise  himself  on  his  bed  or  couch  so  as  to  look 
out  of  the  window ;  and  when  his  wife  visited  him  or  some- 
thing deeply  affecting  him  was  said  in  his  hearing,  he  showed  by 
a  slight  twittering  of  the  closed  eyelids  or  by  a  shrinking  move- 
ment that  he  was  not  so  insensible  as  he  looked.  Moreover 
when  he  came  to  himself  at  the  end  of  his  long  nightmare  he 
had  a  very  fair  remembrance  of  what  had  taken  place  while  he 
was  under  its  spell :  the  Franco-German  war  had  broken  out  and 
run  its  course,  and  he  had  gathered  from  the  conversation  of  his 
[attendants  a  general  notion  of  the  events  of  it.  Once  he  had 
lost  his  reckoning  of  the  month  for  a  time,  but  had  managed  to 
regain  it  by  seeing  the  date  on  a  newspaper. 

In  other  melancholies,  movements  that  seem  to  be  almost 
automatic  serve  to  give  monotonous  expression  to  their  grief: 
they  moan  or  groan  piteously  with  each  expiration ;  repeat  in  a 
whisper  or  aloud  the  same  ejaculation  of  distress ;  rock  their 
bodies  to  and  fro  continually ;  wring  their  hands ;  pace  backwards 
and  forwards  over  the  same  piece  of  ground  with  sad  eyes 
fixed  blankly  upon  it.  The  nervous  irritability  of  some  is  so 
great  that  they  cannot  refrain  from  rubbing  or  picking  their  face 
or  scalp  until  disfiguring  sores  are  formed,  or  from  pulling  out 


382  PATHOLOGY  OF  MIND.  [chap, 

their  hair  in  patches,  or  from  gnawing  their  hands  and  fingers. 
They  are  hardly  conscious  of  what  they  do  ;  if  vigorously  re- 
monstrated with  they  may  refrain  for  a  moment,  but  soon  the 
movements,  which  have  become  a  morbid  habit,  begin  again. 
They  illustrate  the  steps  of  the  gradual  transition  from  voluntary 
to  involuntary  acts,  for  it  is  hard  to  say  sometimes  whether  they 
are  voluntary  or  not.  They  certainly  may  be  checked  usually  by 
arousing  a  strong  enough  motive  in  the  patient's  mind  to  exert 
his  will  steadily,  as  may  be  done  by  placing  an  attendant  by 
his  side  with  instructions  to  hold  his  hands  or  to  quietly  take 
hold  of  them  each  time  that  they  go  up  to  his  head  or  face. 
After  a  while  he  will  get  tired  of  that  process  of  restraint  and 
control  his  impulses. 

We  pass  by  gradations  from  these  cases  of  irritable  and  restless 
melancholia  to  those  cases  of  more  acute  melancholia  in  which 
there  is  an  active  expression  of  the  internal  anguish  by  voice, 
gesture,  and  behaviour — a  sort  of  melancholia  agitans ;  the 
patient  rushing  continually  about  in  aimless  agitation,  wringing 
his  hands  wildly,  crying  out  in  loud  lamentations  or  shrieking 
viol-ently,  and  writhing  in  frenzy  if  restrained.  The  excitement 
is  so  great  that  one  does  not  observe  the  symptoms  of  bodily 
depression  that  belong  to  most  of  the  forms  of  chronic  melan- 
cholia ;  in  fact,  the  features  generally  are  like  those  of  acute 
mania,  so  much  so  sometimes  that  it  is  a  chance  whether  the 
case  is  classed  under  mania  or  under  melancholia.  What  may 
be  noted,  however,  with  regard  to  acute  melancholic  activity — 
whether  of  delirious  ideas  or  of  frenzied  conduct — is  that,  although 
very  great,  it  is  of  a  more  uniform  or  even  monotonous  character 
than  the  corresponding  activity  of  acute  mania  ;  it  is  limited  to 
the  expression  of  the  mental  suffering,  or  to  the  frequent  attempt 
to  escape  from  it  by  suicide,  and,  when  surveyed  as  a  whole,  is 
strongly  suggestive  of  a  machine  in  deranged  action.  It  must 
not  be  suj)posed,  however,  that  a  distinct  line  can  be  drawn 
between  the  group  of  symptoms  which  it  is  the  custom  to 
describe  as  melancholia  and  those  which  are  called  mania ;  in 
some  instances  they  pass  insensibly  into  one  another,  while  in 
other  instances  they  alternate. 

The  following  case  may  serve  as  an  example  of  ordinary  acute 


viii.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  383 

melancliolia.  A  young  woman,  yet.  twenty-fc  u ',  whose  parents 
were  Dissenters  in  a  respectable  position,  had  been  religiously 
brought  up ;  she  had  been  much  engaged  in  Sunday-school  work, 
and  had  written  several  little  tracts  of  more  or  less  merit. 
When  first  seen  by  me  she  was  said  to  have  been  ill  for  two 
months,  but  there  was  reason  to  believe  that  she  had  suffered 
for  a  longer  period.  She  was  miserably  restless  and  unhappy, 
and  wandered  about  moaning  and  exclaiming,  "My  poor  father ! 
My  poor  father ! "  She  also  spoke  incoherently  of  the  house 
being  burnt  down,  and  of  every  one  in  it  being  lost ;  and  she 
made  several  attempts  at  suicide.  There  was  a  background  of 
anguish  behind  the  excitement,  marking  a  difference  from  acute 
mania,  where  the  mood  is  elated,  or,  if  the  elation  disappears 
during  a  remission,  is  sullen,  moody,  and  morose.  After  a  little 
wdiile  she  became  still  worse :  she  was  much  excited  during  the 
day,  rushing  wildly  at  any  door  the  moment  it  was  opened, 
grasping  at  the  clothes  of  any  one  who  might  enter,  and  clinging 
to  them  with  offensive  tenacity  ;  and  at  night  she  slept  not,  tore 
to  pieces  bed-clothes,  nightdress,  and  whatever  else  she  could 
tear,  and  plastered  herself  and  her  chamber  with  her  excrement. 
Day  by  day  she  seemed  to  get,  if  possible,  worse  and  worse,  gab- 
bling automatically  some  such  sentence  as  "  Let  me  see  my  poor 
father-;  let  me  kiss  my  poor  father,"  and  making  the  most  frantic 
rushes  at  any  door  that  was  opened,  no  matter  where  it  led  to. 
Night  was  not  the  time  for  sleep,  but  for  the  awakening  of  a 
more  disgusting  frenzy.  Withal  it  was  clear  that,  notwithstand- 
ing her  terrible  and  distressing  excitement,  she  knew  what  she 
was  doing,  and  could  control  herself  in  some  measure  for  a  time ; 
she  did  not  like,  for  example,  to  be  put  in  seclusion,  and  the 
threat  or  employment  of  that  means  of  treatment  had  a  calming 
effect  upon  her.  On  the  whole,  there  was  certainly  an  appear- 
ance of  wilfulness  in  the  worst  acts  of  this  poor  woman,  whom 
an  ordinary  observer  would  have  pronounced  the  maddest  person 
that  he  could  imagine;  she  was  perfectly  conscious  whether 
she  was  doing  what  she  should  do  or  should  not  do ;  and  if  a 
sufficiently  powerful  motive  was  excited,  she  could  sometimes 
restrain  the  automatic  utterance  of  her  convulsive  frenzy.  Had 
the  supremely  absurd  question  whether  she  knew  the  difference 


384  PATHOLOGY  OF  MIND.  [chap. 

between  right  and  "wrong  been  put  to  a  medical  witness  in  her 
case,  the  reply,  so  for  as  rational  answer  could  be  made  to 
irrational  question,  must  needs  have  been  that  she  did.  In  this 
case  the  so-called  asylum  ear,^  which  is  ever  of  evil  augury, 
appeared  first  on  one  side  and  then  on  the  other,  and  the  end 
was  the  natural  end  of  such  cases, — namely,  dementia  :  the  fury 
had  raged  out,  and  the  calm  of  mental  extinction  followed  :  by 
making  a  desert  of  the  mind  peace  was  made  in  it.  As  in  the 
natural  order  of  events  convulsion  is  the  forerunner  of  paralysis, 
so  maniacal  fury  is  the  forerunner  of  dementia  in  the  regular 
course  of  mental  des^eneration. 

Suicidal  feelings  and  attempts  are  common  in  melancholia ; 
so  much  so  that  one  suspects  their  actual  or  possible  existence 
even  when  they  have  not  been  openly  manifested.  Suicide  is 
sometimes  attempted  or  accomplished  in  consequence  of  a  hallu- 
cination, which  perhaps  occurs  very  suddenly  to  the  depressed 
mind — it  may  be  at  the  instant  of  awaking  from  sleep :  the 
patient  hears  distinctly  a  voice  commanding  him  to  kill  himself; 
so  mysterious,  so  entirely  independent  of  himself,  so  imperative 
does  it  seem,  that  he  thinks  it  a  command  from  heaven  or  a 
temptation  from  hell.  In  the  latter  case  he  may  withstand  and 
overcome  it  for  a  time  or  altogether;  in  the  former  he  is  not 
unlikely  to  yield  early  obedience  to  it.  Again,  suicide  may  be 
the  consequence,  direct  or  indirect,  of  a  delusion,  or  it  may  be 
sought  as  an  escape  from  a  misery  which  is  intolerable.  The 
two  delusions  which  are  most  often  accompanied  by  suicidal 
tendencies  are  the  delusions  of  eternal  damnation  and  of  im- 
pending worldly  ruin.    It  has  been  truly  said  that  the  fear  of 

^  The  "Insane  Ear" — Hfematoma  auris,  or  Oth£eraatoraa — is  produced 
by  gradual  effusion  of  blood  under  the  perichondrium,  which  is  stripped 
from  the  cartilage,  or,  in  some  cases,  by  an  effusion  within  the  cartilage. 
The  effused  blood  may  remain  some  time  in  the  cystic  stage,  absorption 
finally  taking  place,  and  the  ear  becoming  dry  and  shrivelled.  When  this 
bloody  swelling  appears,  the  prognosis  is  very  unfavourable.  Some  have 
attributed  it  to  a  traumatic  cause,  but  its  gradual  manner  of  coming  on, 
its  symptoms  and  duration,  are  widely  different  from  those  of  a  contusion. 
Dr.  Stiff,  who  has  investigated  its  nature  most  carefully,  believes  that 
there  is  no  foundation  for  supposing  it  to  be  produced  by  injury. — • 
("  Hsematoma  auris,"  Brit,  and  For.  Review,  1858.)  At  the  beginning  its 
progress  may  be  checked  sometimes  in  a  remarkable  manner  by  painting 
the  ear  with  a  solution  of  cantharides. 


Mil.]  THE  SYxAlPTOMATOLOGY  OF  INSANITY.  385 

poverty  has  caused  more  suicides  than  any  insane  delusion 
except  the  fear  of  hell.  Certainly  it  seems  curiously  inconsistent 
that  the  patient  who  is  unspeakably  miserable  because  he  has 
sinned  beyond  hope  of  pardon,  and  expresses  the  utmost  agony 
because  his  soul  is  doomed  to  eternal  damnation,  should  be  so 
frequently  driven  to  precipitate  the  fate  which  he  dreads,  and 
the  dreael  of  whicli  he  believes  to  be  the  entire  cause  of  his 
misery  on  earth.  Therein  nature  shows  itself  deeper  and 
stronger  than  creeds ;  by  an  impulse  whose  roots  go  far  down 
below  any  conscious  motive  it  declares  its  certainty,  and  seeks 
the  relief,  of  the  annihilation  of  a  tormented  self.  One  may  point 
out  to  the  unhappy  sufferer  that,  by  his  own  showing,  suicide 
will  only  be  the  entrance  to  a  greater  and  an  eternal  weight  of 
anguish  ;  he  wiU  acknowledge  that  he  knows  it  too  well ;  never- 
theless he  is  urged  irresistibly  by  an  inspiration  from  the  depths 
of  his  being  to  get  quit  of  the  intolerable  burden  of  life.  In  the 
same  way  an  exaggerated  fear  of  poverty  oftentimes  causes  the 
melancholic  to  put  an  end  to  his  apprehensions  by  suicide :  he 
may  be  deemed  to  act  from  an  implicit  certitude  that  there  is 
nothing  in  life  of  such  worth,  and  nothing  after  it  of  such 
account,  as  to  make  it  reasonable  to  bear  so  great  suffering. 

It  is  most  certain  that  the  happiness  of  living  is  constitutional, 
and  very  different  in  different  persons,  some  having  but  little  of 
it,  while  others  feel  it  so  keenly  that  they  cannot  conceive  any 
one  should  feel  weary  of  the  sun,  or  believe  him  if  he  says  so. 
However  miserable  they  may  be  they  have  not  the  least  inclina- 
tion or  desire  to  end  their  sufferings  by  death  :  so  long  as  they 
breathe  it  is  a  happiness  to  breathe.  Little  as  they  can  conceive 
it,  however,  there  are  persons  afflicted  with  a  constitutional 
melancholy  who  have  no  sense  of  positive  enjoyment  in  living, 
who  go  through  wdth  life  as  with  a  task  that  is  to  them  at  best 
indifferent,  at  worst  burdensome  and  painful,  and  who  at  certain 
times,  when  more  out  of  tune  than  usual,  are  oppressed  with  a 
desponding  sense  of  the  dreary  emptiness  of  life,  with  a  deep 
disgust  of  the  meanness  and  meaninglessness  of  its  strifes,  with  a 
w^eary  apathy  from  all  its  interests.  If  wise,  they  betake  them- 
selves to  steady  work,  wherein  they  gain  a  refuge  from  the 
thoughts  and  feelings  which  come  of  idleness  and  reflection; 


386  PATHOLOGY  OF  MIND.  [chap. 

if  unwise,  tliey  may  resort  to  alcoliolic  stimulants  in  order  to 
counteract  their  depression  and  to  get  the  joy  of  a  temporary 
exaltation  of  mind — a  treacherous  remedy,  which  yields  transient 
relief  at  the  cost  of  a  future  misery  that  may  end  in  suicide.  On 
persons  of  this  melancholic  temperament  the  suicide  of  a  relative 
or  an  acquaintance,  if  such  chance  to  occur,  fastens  and  has  a 
singularly  powerful  effect ;  it  strikes  the  note  of  life-weariness 
which  is  inbred  in  their  nature  and  vibrates  habitually  in  their 
feelings,  and  they  feel  themselves  urgently  impelled  to  follow 
the  example  set  them. 

The  essential  difference  between  an  optimistic  and  a  pessi- 
mistic view  of  life  is  simply  a  question  of  temperament,  and 
arguments  as  to  which  is  the  right  view  between  persons 
who  have  no  common  ground  to  meet  upon  may  be  amusing 
literary  exercises,  but  they  are  not  profitable.  One  person,  as 
he  gazes  into  the  fathomless  depths  of  the  heavens  on  a  calm 
and  cloudless  night  when  all  around  is  silence,  or,  in  a  stillness 
that  is  almost  felt,  looks  down  from  some  Alpine  height  upon 
a  mighty  range  of  snowclad  mountains  resting  one  upon 
another  in  their  eternal  and  majestic  repose,  is  oppressed 
with  so  overwhelming  a  sense  of  the  vastness  and  duration  of 
that  which  is  not  himself  and  of  the  petty  meanness  and  insig- 
nificance of  life,  that  he  wishes  its  fitful  fever  were  over,  and 
his  individuality  merged  into  the  great  whole  whence  in  an  evil 
hour  its  elemental  atoms  took  component  form :  it  is  a  desire  to 
be  one  with  nature  which  is  the  outcome  of  a  want  of  sympathy 
with  the  fleeting  aspirations  and  achievements  of  his  kind. 
Another  person  in  similar  circumstances  has  no  more  sense  of 
such  a  mood  than  a  blind  man  has  of  colour  or  a  deaf  man  of 
sound :  the  glory  of  a  fine  night  to  him  is  that  he  can  walk  out 
and  smoke  his  pipe,  the  grandeur  of  a  mountain  height  that  he 
can  rest  and  eat  comfortably  after  a  long  climb.  If  we  justly 
weigh  these  differences  of  temperament  it  will  appear  that  when 
the  man  hanged  himself  in  order  that  he  might  be  no  longer  at 
the  trouble  of  putting  off  and  putting  on  his  clothes  each  day, 
his  deed  did  not  outgo  the  motive  so  disproportionately  as  is 
commonly  assumed. 

"When  T  have  reasoned  with  melancholies  who  felt  themselves 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  387 

impelled  to  suicide  against  the  right  of  any  one,  however 
miserable,  to  put  an  end  to  his  life,  and  have  pressed  upon 
them  the  commonplace  arguments — that  it  is  base  for  a  soldier 
to  desert  his  post ;  that  each  one  is  bound  to  stay  and  pro- 
vide and  care  for  the  children  whom  he  has  brought  into  the 
world,  whatever  may  be  his  own.  desire  to  get  out  of  it ;  that 
it  will  be  a  wdcked  thing  on  his  part  to  leave  to  his  family  the 
stigma  which  he  will  do  if  he  kills  himself ;  that  he  will  do  in  a 
moment  of  despair  an  irreparable  act  which,  did  he  go  on  living, 
he  might  have  a  thousand  occasions  bitterly  to  regret — and  the 
like ;  I  have  found  the  reasoning,  though  assented  to  probably 
with  the  lips,  to  have  little  practical  weight  with  them  in  their 
calmer  moments,  and  no  weight  at  all  when  the  paroxysm  of 
anguish  overwhelmed  them.  The  penalties  which  society  has 
attached  to  suicide,  in  order  to  express  its  condemnation  of  it  as 
an  antisocial  offence,  a  criminal  desertion  of  duty  on  the  part  of 
one  of  its  members,  a  revolt  against  the  conditions  of  human 
progress,  will  not  touch  one  who  thinks  meanly  of  society  and  its 
highest  aims,  and  foresees  in  imagination  the  time  when  the 
countless  myriads  of  the  human  race  with  its  work  and  worries 
will  have  disappeared  as  completely  as  so  many  myriads  of 
creeping  ants  with  their  works  and  worries. 

The  real  effective  force  against  suicide  is  the  instinctive  love 
of  life,  and  when  a  man  has  lost  that  he  has  no  appreciation  of 
the  good  reasons  that  may  be  given  for  living  ;  they  fail  to  touch 
and  to  take  hold  of  him.  Just  as  the  movements  necessary  to  life — 
those  of  the  heart  and  of  respiration — a,re  independent  of  human 
moods  and  will,  so  there  is  infixed  in  the  intimate  constitution  of 
man's  being  a  stronger  power  than  could  ever  come  of  delibera- 
tion or  be  exerted  by  will  to  ensure  the  continuance  of  life. 
The  instinct  is  the  outcome  in  consciousness  of  the  fundamental 
property  of  all  living  organic  elements  to  assimilate  and  to  in- 
crease, without  which  it  would  not  be  living  matter — a  property 
which,  declining  with  bodily  decay,  extinguishes  gradually  the  old 
man's  love  of  life.  When  a  person's  temperament  is  such  that 
he  cares  not  to  live,  it  marks  a  defect  of  that  fundamental  organic 
nisus  or  energy;  if,  under  the  spell  of  a  morbid  depression,  he 
actually  commits  suicide,  it  is  proof  that  the  organic  element 


388  PATHOLOGY  OF  MIND.  [chap. 

was  then  so  wanting  in  this  fundamental  quality  that  it  could 
not  assimilate  and  increase,  but  must  be  assimilated  and  decrease ; 
wherefore  an  act  of  self-destruction  is  always  proof  of  a  sufficient 
reason,  and  there  is  no  more  to  be  said.  The  one  great  argument 
against  suicide  I  take  to  be  the  instinctive  love  of  life ;  the  one 
convincing  argument  in  favour  of  suicide  is  the  loss  of  that 
instinct. 

Some  melancholic  patients  show  by  despairing  expressions 
tliat  the  idea  of  suicide  is  in  their  minds,  or  they  utter  their 
fear  or  conviction  that  they  shall  do  it  some  day.  Albeit  it  is 
a  common,  it  is  an  erroneous,  notion  that  those  who  talk  of  it  in 
that  way  will  not  go  on  to  act ;  they  may  talk  of  it  for  a  long 
time  and  yet  commit  suicide  at  last.  The  idea  is  familiar  to 
their  minds ;  it  has  lost  the  horror  with  which  it  startles  the 
mind  when  it  first  occurs  to  it ;  opposing  feelings  and  consider- 
ations are  not  so  actively  roused  to  combat  it ;  during  an  acute 
paroxysm  of  misery,  when  the  despair  is  overwhelming,  the 
ever  present  idea,  which  has  perhaps  been  toyed  with  in  the 
first  instance  rather  than  seriously  entertained,  is  carried  into 
convulsive  effect.  Everybody  learns  by  experience  that,  if  he 
would  not  have  an  unwelcome  idea  grow  in  his  mind  until  it 
gains  undue  power  over  it,  it  is  of  the  first  importance  to  dismiss 
it  while  it  is  yet  a  stranger ;  and  assuredly  constant  thinking 
about  death  makes  the  way  to  suicide  easier.  Very  few  persons 
have  committed  suicide  who  have  not  pathetically  hinted  or 
expressed  on  some  occasion  or  other  the  danger  in  which  they 
were ;  but  having  been  met  by  incredulity,  or  banter,  or  a 
boisterous  and  unsympathetic  encouragement  to  get  rid  of  such 
foolish  ideas,  they  have  shrunk  back  from  making  further  con- 
fidences, and  have  shown  by  the  sad  event  how  earnest  their 
slighted  fears  were.  Oftentimes  the  balance  shall  oscillate  for 
a  long  time  between  the  impulse  to  live  and  the  impulse  to  end 
life,  and  it  may  be  that  a  slight  change  of  mood,  a  very  straw, 
will  turn  it  this  way  or  that.  As  I  have  said  already,  the  early 
morning,  when  they  awake  too  soon  to  renewed  suffering  and, 
tossing  about  in  misery,  go  through  in  imagination  the  apprehen- 
sions and  fears  of  their  morbid  state,  is  a  particularly  dangerous 
time  for  melancholic  patients  who  are  suicidally  disposed. 


viik]  the  symptomatology  OF  INSANITY.  380 

Different  from  the  ordinary  melancholic  who  commits  suicide 
in  consequence  of  a  delusion  or  in  order  to  escape  from  the 
intolerable  misery  of  his  state  is  he  who,  free  from  delusion  of 
any  kind,  is  possessed  by  a  single,  strong,  dominant  impulse  to 
do  it.  He  is  the  most  dangerous  to  himself  of  all  melancholies  : 
he  may  reason  about  the  morbid  impulse  almost  as  well  as  a 
perfectly  sane  man  could,  he  may  deplore  it,  be  in  despair  about  it, 
and  may  even  pretend  a  thankfulness  to  have  got  quit  of  it ;  but, 
notwithstanding  his  own  knowledge  of  its  nature,  and  notwith- 
standing the  greatest  watchfulness  on  the  part  of  those  around 
him,  he  usually  succeeds  in  the  end  in  carrying  it  into  effect, 
either  suddenly  at  the  instigation  of  a  favourable  occasion,  the 
sight  of  means  to  do  the  ill  deed  making  the  ill  deed  done,  or 
methodically  with  cunning  foresight  in  plan  and  ingenuity  in 
execution.  It  is  where  some  other  member  of  the  family  in  a 
former  generation  has  committed  suicide,  and  where  the  impulse 
therefore  has  its  roots  deep  in  the  foundations  of  the  person's 
nature,  that  it  is  most  powerful,  most  independent  of  reflection, 
most  persistent,  and  most  likely  to  have  its  way  in  the  end. 

Other  dangerous  impulses  displayed  by  some  melancholies 
are  homicidah  Like  suicide,  homicide  may  be  done  in  conse- 
quence of  a  hallucination  or  of  a  delusion  :  in  a  few  instances 
the  patient  hears  a  voice  commanding  him  directly  to  kill,  or 
has  some  extravagant  delusion  that  he  must  sacrifice  life  in 
order  to  confer  a  great  benefit  on  the  world ;  most  often  he 
believes  himself  to  be  the  victim  of  a  malignant  and  persistent 
persecution,  by  which  he  is  driven  at  last  to  such  a  frenzy  that 
he  attacks  and  perhaps  kills  his  imagined  persecutor.  Poisonous 
fumes  or  vapours  are  diffused  through  his  room  in  the  night,  or 
indecent  assaults  are  made  upon  him  in  his  sleep ;  strangers 
call  him  offensive  names,  or  make  abominable  accusations,  or 
use  insulting  gestures  as  they  pass  him  in  the  streets ;  his 
enemies  have  caused  him  to  have  some  obscure  disease  which 
is  slowly  wasting  his  manly  vigour,  or  prowl  around  his  premises 
and  interfere  in  his  affairs,  so  that  nothing  prospers  with  him ; 
if  he  has  a  smattering  of  education  he  will  say  that  his  nerves 
are  tortured  by  the  secret  use  of  electricity  or  by  some  more 
mysterious  agency;  but  if  he  is  ignorant  and  superstitions  he 


390  PATHOLOGY  OF  iMIND.  [chap. 

fancies  that  he  has  been  bewitched.  Worn  out  by  what  he 
suffers,  he  appeals  to  the  police  or  to  the  magistrates  to  protect 
him,  and,  getting  no  redress  from  them,  arms  himself  in  self- 
defence  -svith  dagger  or  revolver ;  changes  his  lodgings  frequently 
in  order  to  elude,  or  tries  all  sorts  of  schemes  to  frustrate,  the 
machinations  of  his  persecutors;  goes  on  from  week  to  week, 
from  month  to  month,  and  perhaps  from  year  to  year,  suffering, 
complaining  from  time  to  time  to  the  authorities,  scheming  to 
protect  himself,  and  at  last  is  brought  to  such  a  pitch  of  despe- 
ration, or  so  far  loses  self-control  under  the  influence  of  a 
temporary  bodily  disorder,  that  he  makes  a  fatal  attack  upon 
some  person  who  is  innocent  of  having  done  him  the  least  harm. 
A  suspicious  husband  is  sure  that  his  wdfe  is  unfaithful  to  him, 
on  grounds  that  are  ludicrously  inadequate  to  warrant  the  sus- 
picion, and,  sensible  as  he  seems  in  other  respects,  sees  proof  of 
what  he  grossly  imagines  in  the  most  trivial  and  innocent  inci- 
dents, believing  adultery  to  be  committed  in  almost  impossible 
situations;  he  broods  over  his  calamity  until  it  becomes  an 
insupportable  w^rong,  and  in  the  end  perhaps  takes  a  fatal 
revenge  upon  her  or  upon  her  supposed  paramour. 

Patients  who,  having  such  delusions  of  being  wronged  or  per- 
secuted as  I  have  described,  exhibit  deep  brooding  depression, 
and  especially  those  of  them  in  w4iom  the  depression  is  of  a 
hypochondriacal,  sullen,  and  moody  character,  are  often  very  dan- 
gerous to  others  and  ought  not  to  be  suffered  to  go  at  large ;  for 
it  is  impossible  to  predict  at  what  moment  the  fury  bred  of 
their  insane  feelings  and  ideas  may  sweep  away  self-control  and 
hurry  them  into  a  deed  of  desperate  violence.  However,  not 
every  one  who  has  delusions  of  persecutions  is  necessarily  a 
dangerous  lunatic  :  each  case  ought  to  be  judged  upon  its  merits, 
the  character  of  the  patient  and  the  special  features  of  his 
depression  ^^eing  weighty  facts  to  be  taken  into  account.  Some 
who  are  thus  wrong-minded  are  of  an  open  disposition,  talk 
freely  of  their  troubles,  and  are  for  the  most  part  tolerably 
cheerful :  they  proclaim  their  grievances  loudly  to  all  the  world, 
declaim  vigorously  against  their  enemies,  appeal  repeatedly  to 
the  police  and  to  courts  of  justice,  write  to  the  Queen, 
threaten  what  they  will  do  if  a  stop  is  not  put  to  the  persecution. 


Yiii.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  391 

are  great  social  nuisances,  but  do  no  serious  mischief,  beinf^ 
satisfied  for  the  most  part  to  proclaim  their  wrongs.  Moreover, 
women  are  less  dangerous  than  men,  since  it  is  not  the  custom 
of  women  to  resort  to  personal  violence  to  avenge  their  wrongs ; 
old  men  are  less  dangerous  than  men  who  are  in  the  turbulent 
vigour  of  youth  or  in  the  more  sedate  vigour  of  manhood,  since 
with  the  decay  of  passion  and  energy  that  marks  the  decline  of 
old  age  it  becomes  more  easy  to  endure  and  less  easy  to  retaliate. 
Persons  of  an  energetic,  self-asserting,  and  dictatorial  tempera- 
ment are  more  dangerous  than  persons  of  an  opposite  self-dis- 
trusting temperament,  since  they  will  be  disposed  to  attack  others 
while  the  latter  will  be  more  likely  to  do  harm  to  themselves. 

So  far  I  have  taken  notice  of  homicide  done  in  two  conditions 
— namely,  directly  at  the  instigation  of  delusion,  and  under  the 
compulsion  of  passion  bred  of  insane  delusion.     In  the  latter 
case  the  passion,  be  it  jealousy,  envy,  anger,  revenge,  is  so  much 
like  ordinary  passion  that  it  is  sometimes  hard  to  think  a  person 
who  yields  to  it  is  not  perfectly  responsible  for  what  he  does ; 
sane  or  insane,  it  may  be  thought,  it  was  his  duty  to  have  con- 
trolled a  passion  whose  evil  nature  he  was  conscious  of.     But 
he  might  know  its  nature  and  yet  not  be  able  to  control  it. 
Because  an  insane  person  feels  the  same  passions  as  a  person 
who  is  in  his  right  mind,  it  by  no  means  follows  that  he  is 
therefore  sane,  as  many  persons  seem  incontinently  to  assume, 
or   that  he  has  the  same   power  of  control  over   them.     The 
passion  is  easily  kindled  in  a  diseased  mind,  smoulders  there  in 
consequence,  and  from  time  to  time  is  inflamed  by  the  insane 
delusion  which  accompanies  it ;  and  before  we  venture  to  assume 
that  he  could  and  should  always  check  or  quench  it,  we  ouoht 
to  be  sure  that  the  disease  from  which  it  has  sprung  has  not  so 
inflamed  it  and  so  weakened  the  will  as  to  render  the  contest 
between  them  an  unequal  and  forlorn  one.     It  is  notorious  that 
a  sane  person  when  under  the  dominion  of  strong  passion  is 
carried  out  of  himself  to  do  acts  which  he  would  never  do  in 
his  temperate  moments — that  his  passion  is  truly  a  short  mad- 
ness :  how  absurd  then  is  it  to  exact  that  in  the  unsound  mind, 
where   consensus   of    functions   is   weakened  or  destroyed  by 
disease,  the  morbid  passion   should  be  always  under  control ! 


392  PATHOLOGY  OF  MIND.  [chap. 

As  a  matter  of  fact  it  is  not :  just  as  when  there  is  disease  of 
the  nervous  system  a  movement  is  easily  provoked  and  made 
convulsive  which  is  perfectly  under  control  when  the  person  is 
in  good  health,  so  when  there  is  disease  of  mind  a  passion  is 
easily  provoked  and  made  uncontrollable  which  is  kept  in 
subjection  when  the  mind  is  sound. 

I  ought  not  to  omit  to  mention  that  homicide,  like  suicide,  is 
done  in  some  instances  during  a  paroxysm  of  melancholic  panic, 
without  premeditation,  without  reflection,  without  distinct  mo- 
tive, almost  witliout  consciousness  at  the  time.  The  unfortunate 
sufferer  is  so  overwhelmed  with  the  anguish  of  the  moment  that 
it  must  find  an  outlet  in  some  discharge  of  frantic  energy  ;  and 
when  the  act  is  done,  he  obtains  ease  and  calm,  comes  to  himself, 
and  for  the  first  time  realises  the  gravity  of  what  lie  has  done. 
So  far  from  evincing  the  distress  and  remorse  which  might  then 
be  expected,  he  has  perhaps  the  apathetic  look  of  a  person  who 
is  exhausted  or  stupefied  by  violent  emotional  agitation. 

Closely  akin  to  these  cases  are  those  in  which  a  melancholic 
father  or  mother  kills  one  or  more  of  their  children  from 
motives  which,  if  an  attempt  be  made  to  give  an  account  of 
them  afterwards,  seem  singularly  inadequate.  The  sort  of 
alleged  motive  is  perhaps  that  they  could  not  bear  to  see  them 
starve,  and  felt  it  would  be  better  for  them  to  be  dead ;  or  they 
may  not  be  able  to  say  what  motive  they  had  to  kill  them ;  the 
truth  being  probably  that  there  was  not  a  clearly  conceived 
motive  at  the  time,  that  the  act  was  done  in  a  paroxysm  of 
melancholic  anguish,  and  that  the  person,  when  pressed  for  an 
explanation,  lays  hold  of  any  gloomy  idea  that  he  may  have 
had,  however  inadequate,  which  appears  to  be  an  explanatory 
motive.  Perhaps  it  was  that  just  before  the  deed  a  frenzied 
idea  that  they  must  do  it  started  up  suddenly  out  of  the  sub- 
stratum of  deeply  despondent  feeling  under  which  they  laboured 
and  hurried  them  into  the  homicidal  act. 

Lastly,  there  are  those  more  chronic  cases  of  which  I  have 
already  spoken  under  the  head  of  impulsive  insanity,  where  the 
unfortunate  person  is  afflicted  by  a  homicidal  idea,  sometimes 
quiescent,  at  other  times  so  active  that  he  is  in  an  agony  of  ap- 
prehension lest  he  shall  yield  to  it,  but  hardly  ever  leaving  him 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  393 

free  from  its  tormenting  impulses.  He  may  be  so  much  depressed 
in  some  instances  as  to  present  a  picture  of  genuine  melancholia; 
but  in  other  cases  it  is  remarkable  how  little  evidence  of  his 
sufferings  is  presented  to  outsiders,  who  may  be  quite  ignorant 
of  what  he  undergoes  until  he  confides  his  sorrows  to  them. 

The  course  which  melancholia  runs  is  to  recovery  in  half  or 
more  than  half  the  cases.     In  almost  all  cases  there  are  great 
variations  from  time  to  time  in  the  intensity  of  the  symptoms, 
and  these  variations  sometimes  take  place  very  suddenly  :    a 
patient  shall  be  calm  and  composed  in  the  afternoon  who  was 
in  a  perfect  frenzy  of  agitated  distress  in  the  morning.     Some- 
times there  are  complete  intermissions  of  the  symptoms  for  a  few 
hours  or  for  a  day,  and  then  they  return  in  all  their  intensity. 
For  the  most  part  these  sudden  conversions  from  deep  gloom  to 
apparent  sanity  are  not  to  be  relied  upon  to  be  histing ;  but  I 
have  met  with  two  instances  in  which  the  recovery  was  quite 
sudden  and  yet  was  lasting,  the  acute  melancholic  symptoms 
having  ceased  abruptly,  without  the  least  sign  of  so  happy  an 
event  having  been  noticed  beforehand.     Usually  when  recovery 
really  takes  place,  it  does  so  by  very  gradual  steps,  the  patient 
going  up  and  down,  but  on  the  whole  makiDg  an  ascent :  he 
begins  to  notice  and  to  interest  himself  in  what  is  going  on 
around  him,  altho\]gh  he  is  probably  very  unwilling  to  have  it 
observed  that  he  is  doing  so,  and  may  abandon  these  hopeful 
beginnings  if  they   are   imprudently  commented  upon  in  his 
presence  as  proofs  of  improvement;  he  will  take  up  a  news- 
paper and  look  at  it  if  no  notice  be  taken,  putting  it  down 
at  once  if  attention  is  drawn  to  him  or  declariDg  that  he  is 
not  interested  in  it  and  cannot  even  understand  it ;  he  is  less 
averse  from  being  made  personally  clean  and  tidy,  or  begins 
himself  to  have  a  little  care  for  his  appearance;  he  employs 
himself  in  some  way,   and  evinces  the   return  of  his   natural 
aflections  and  interests  by  inquiring,  at  first  timidly  as  if  he  were 
ashamed  of  his  new-born  interest,  and  afterwards  openly,  about 
his  family  and  his  affairs.     These  indications  of  natural  feelin^. 
though  slight,  are  happy  omens ;  they  are  breaks  in  the  dark 
mist  of  feeling  which  has  overspread  the  intellect,  but  which 
is  now  beginning  to  rise  and  will  probably  go  on  to  do  so  until 


394  PATHOLOGY  OF  MIND.  [ceap. 

the  whole  mind  is  clear.  ]\Ieanwhile  the  delusions  lose  energy 
and  abate  in  activity  ;  he  speaks  less  often  and  less  openly  of 
them,  and  shows  by  his  behaviour  a  commencing  doubt  or  dis- 
trust of  them,  though  he  will  still  probably  hold  to  them  when 
directly  challenged;  by  degrees  they  fade  away,  as  healthy 
thoughts  and  work  engage  more  and  more  of  the  attention, 
and  at  last  he  comes  to  himself  entirely,  as  one  who  has 
awakened  with  joy  out  of  a  dreadful  dream  which  was  incon- 
ceivably real  while  it  lasted.  An  animation  of  the  bodily 
functions  goes  along  with  the  brightening  of  mind:  digestion 
improves,  the  bowels  act  more  regularly  of  their  own  accord, 
the  skin  and  hair  lose  their  dryness  and  harshness,  the  nutrition 
generally  is  better,  the  circulation  is  more  vigorous,  and  the 
suppressed  menstrual  functions  in  women  are  restored.  The 
recovery  in  most  cases  is  within  from  three  to  twelve  months 
from  the  outbreak  of  the  illness;  after  twelve  months  have 
passed  without  signs  of  amendment  it  is  less  probable,  but  still 
not  hopeless;  for  many  instances  are  on  record  in  which  it 
has  occurred  at  a  later  period,  and  there  have  been  a  few  ex- 
ceptional instances  of  recovery  after  years  of  suffering.  Some 
melancholies,  particularly  those  who  have  had  delusions  of 
persecution,  never  return  entirely  to  good  feelings  and  abandon 
their  suspicions  even  when  they  are  supposed  to  be  recovered  : 
they  will  not  sincerely  admit  that  they  have  been  ill,  are  hostile 
to  those  who  have  put  them  imder  treatment  or  who  have 
treated  them,  and  maintain  that  there  was  no  reason  whatever 
for  interfering  with  them. 

The  course  of  melancholia,  when  it  is  not  to  recovery,  is  to 
one  of  four  issues :  either  it  lapses  into  a  chronic  state  which 
continues  for  the  rest  of  life ;  or  it  goes  on  to  such  increasing 
mental  weakness  as  to  become  actual  dementia ;  or  it  ends  in 
death  from  exhaustion,  aided  commonly  by  some  intercurrent 
disease — plithisical,  cardiac,  or  abdominal — and  especially  phthi- 
sis; or  lastly,  it  now  and  then  passes  into  the  opposite  condition 
of  mania,  the  patient  disappointing  the  confident  expectations  of 
recovery  which  his  symptoms  of  returning  animation  raise, 
by  the  supervention  of  an  extreme  elation  and  by  getting  more 
and  more  excited  until  he  is  actually  maniacal.      When  this 


\^1I.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  395 

transformation  takes  place  it  is  not  of  good  augury,  for  it  is  too 
probable  tliat  there  will  be  a  return  of  the  depression  after  the 
excitement  has  subsided.  Death  is  owing  in  some  cases  to 
exhaustion  consequent  upon  persistent  refusal  of  food,  the  fatal 
event  being  hastened  at  last  either  by  diarrhoea  or  by  a  low 
form  of  pneumonia,  which  sometimes  passes  quickly  into  gan- 
grene of  the  lung.  It  is  obvious  that  the  great  and  general 
depression  of  nervous  tone  is  very  suited  to  increase,  very 
unsuited  to  check,  any  disease  that  may  be  going  on  in  other 
organs  than  the  brain  ;  wherefore  the  prognosis  concerning  such 
disease  will  always  be  more  grave  than  where  there  is  no 
nervous  depression. 

Mania. 

I  go  on  now  to  describe  the  class  of  symptoms  of  mental 
derano-ement  which  it  is  asjreed  to  call  mania.  The  dominant 
note  of  them  is  an  excitement  or  exaltation  of  the  self-feeling^ 
which  finds  outlet  in  a  sense  of  extraordinary  well-being,  in 
elated  ideas,  and  in  self-confident  actions  of  the  most  extrava- 
gant kind.  In  a  few  cases  acute  mania  has  come  as  a  sudden 
explosion  without  any  premonitory  symptoms,  after  some 
powerful  moral  impression,  or  after  great  physical  exhaustion, 
or  after  excesses  of  some  sort ;  but  this  sudden  outbreak  is  un- 
usual, and  when  it  has  occurred  there  has  probably  been  a 
strong  hereditary  predisposition  to  insanity.  Most  often  there  is 
a  forewarning  of  the  calamity — a  precursory  stage  of  depression, 
of  shorter  or  longer  duration,  sometimes  so  short  as  to  escape 
notice,  at  other  times  lasting  for  weeks  or  even  months ;  the 
patient  feels  sad,  ill,  apprehensive,  without  knowing  why, 
having  a  vague  foreboding  of  some  misfortune  being  about  to 
happen ;  perhaps  he  has  a  definite  fear  that  he  will  go  mad,  and 
anxiously  seeks  medical  advice  for  himself.  Like  the  unac- 
countable sadness  which  sometimes  goes  before  the  outbreak  of 
a  fever,  his  depression  is  the  projected  shadow  of  a  coming 
calamity,  a  forefeeling  of  it  which  is  replaced  after  a  time  by  an 
opposite  state  of  great  excitement,  sleeplessness,  restlessness, 
unbounded  self-confidence,  extravagance  of  conduct,  rapid  flow  of 
imperfectly  associated  or  entirely  incoherent  ideas,  and  by  hallu- 


396  PATHOLOGY  OF  MIND.  [chap. 

cinations  and  delusions  of  various  kinds,  with  utter  scorn  of  the 
suggestion  of  medical  advice ;  for  he  is  now  as  exultant  as  he 
was  down-hearted  a  little  while  ago.  In  a  few  instances  I  have 
noticed  that  ecstatic  visions  during  the  night,  perhaps  of  a  very 
vivid  character,  have  gone  before  an  acute  maniacal  outbreak  ; 
insomuch  that  if  an  elated  patient  has  seen  in  the  night  an 
angel  who  has  brought  a  message  from  heaven,  or  has  been 
visited  by  Jesus  Christ,  I  look  forward  to  a  very  acute  attack 
with  great  excitement  and  violence,  and  possible  death  by  ex- 
haustion. Lastly,  the  outbreak  of  acute  mania  may  be  the 
gradual  development  of  a  chronic  state  of  moroseness,  sus- 
picion, restlessness, — the  outcome  of  a  sort  of  subacute  state 
which  has  increased  by  degrees  until  it  has  culminated  in  an 
acute  attack.  The  experienced  physician  is  not  always  sorry  to 
see  the  frantic  outbreak  in  such  case,  since  he  feels  a  hope  that 
after  the  mind  has  gone  through  the  furious  storm  it  may  be 
found  free  from  the  morbid  thoughts  and  feelings  which,  while 
the  malady  was  chronic,  could  not  be  gathered  to  a  head  and 
dispersed  ;  the  result  being  much  as  when  a  chronic  inflamma- 
tion which  has  defied  treatment  is  found  to  have  gone  after  the 
supervention  and  disappearance  of  a  more  acute  inflammation. 

It  is  impossible  to  describe  adequately  the  conduct  of  a 
person  during  acute  mania;  for  it  is  all  that  imagination  can 
picture  of  the  ridiculous,  the  noisy,  the  fantastic,  the  furious, 
the  violent,  the  disgusting,  in  different  cases.  The  distempered 
moods  and  ideas  are  translated  instantly  into  excited  acts,  which 
may  be  of  a  harmless  kind,  as  singing,  shouting,  dancing,  writing 
endless  letters  to  great  personages,  rearranging  in  methodical 
disorder  the  furniture  of  the  room,  tearing  up  grass,  and  the  like 
meaningless,  busy  activity;  or  may  be  threatening,  abusive, 
violent,  and  destructive,  especially  where  opposition  is  offered 
to  the  instant  gratification  of  the  mood,  or  to  the  realisation  of 
the  scheme  of  the  moment.  Between  the  sane  and  insane  being 
the  contrast  is  so  extreme  that  it  is  not  easy  to  realise  that  they 
are  the  same  person :  at  one  time,  for  example,  we  have  the 
graceful,  modest  and  delicately -nurtured  young  lady,  whose 
every  word  and  act  are  gentle  and  refined  ;  at  another  time  we 
are  amazed  and  horrified  at  the  coarse  and  indecent  gestures  of  a 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  397 

furious  virago,  her  volubility  in  tlie  use  of  abusive,  blasphemous 
and  obscene  words,  which  it  is  hard  to  believe  she  ever  could  have 
heard,  her  bold  and  ferocious  mien,  her  violent  and  destructive 
acts.  She  is  morally  naked  and  not  ashamed,  as  she  would  make 
no  scruple  to  be  corporeally  in  some  instances.  Day  after  day 
and  week  after  week  this  demoniacal  state  continues;  at  last 
it  subsides,  passes  off,  and  once  more  we  have  the  modest  and 
gentle  lady  whom  it  seemed  inconceivable  we  should  ever  see 
again. 

Before  matters  have  reached  this  height  of  incoherent  fury 
there  are  symptoms  which  it  will  be  well  to  consider  briefly. 
The  patient,  in  the  first  instance,  is  often  happy  beyond 
measure  in  an  extraordinary  feeling  of  unfettered  mental  power, 
evinces  a  supreme  self-confidence  and  elation,  and  acts  and 
looks  very  much  like  a  person  who  is  half  intoxicated.  His 
natural  reserve  and  prudence  are  replaced  by  conlident  address, 
by  vainglorious  pretensions,  by  bold  and  reckless  projects; 
nothing  is  difficult  to  him ;  he  conceives  and  is  eager  to  put 
into  action  grand  schemes  of  pecuniary  speculation,  or  of  politi- 
cal reform,  or  of  scientific  discovery ;  he  will  sing  who  knows 
nothing  of  music,  or  will  frequently  and  confidently  speak  at 
public  meetings,  though  a  speech  in  public  would  be  the  last 
thing  he  would  try  to  make  were  he  in  his  sound  senses ;  withal 
he  is  sly,  crafty  and  untruthful.^  It  cannot  be  denied  that  he 
sometimes  evinces  acute  insight,  recalls  forgotten  ideas,  makes 
witty  and  satirical  remarks,  puns  cleverly  upon  words,  strings 
together  rhymes,  hits  upon  acute  comparisons,  and  displays 
eloquence  of  speech,  after  a  fashion  that  transcends  the  range 
of  his  sane  capacities.  So  far  there  is  a  resemblance  between 
mania  and  the  prophetic  frenzy — fiavir]  and  fiavmcrj ;  in  both 
there  is  an  inspiration  which  giveth  an  unaccustomed  under- 
standing, an  inspiration  which,  being  involuntary  and  not  in 
the  least  due  to  any  conscious  exercise  of  faculty,  but  due  to 
the  exaltation  of  feeling  arising  from  the  organic  state,  shows 

1  "I  then  felt  so  happy  !  my  memory  was  clear  and  facile,  and  nothing 
fettered  my  mind,  but  at  the  same  time  I  was  crafty  and  sly,  nay  mali- 
cious." These  were  the  words  of  a  patient  after  his  recovery  to  Dr. 
Willis. 


398  PATHOLOGY  OF  MIND.  [chap. 

liow  little  consciousness  and  will  have  to  do  directly  with  the 
highest  products  of  mental  activity.  This  stage  of  premaniacal 
"brilliancy  in  no  case  lasts  long;  impatient  of  interference,  the 
patient  is  easily  irritated  by  opposition,  however  gentle  it  be,  and 
gets  much  excited  if  it  be  at  all  serious  ;  and  in  any  case  his 
state  of  exaltation  is  likely  to  run  quickly  into  incoherent  frenzy. 
Let  it  be  particularly  noted  here  how  the  overthrow  of 
reason  is  accompanied  and,  indeed,  preceded  commonly  by  a 
perversion  or  destruction  of  moral  feeling ;  the  last  acquisition 
of  social  culture  in  the  most  advanced  races  of  men  being  the 
first  to  show  the  effects  of  the  disorder  whose  end  is  to  make 
the  individual  a  social  discord.  Candour  is  supplanted  by  craft, 
veracity  by  cunning  misrepresentation  or  actual  falsehood,  re- 
serve by  impudence,  modesty  by  indecency,  refinement  of  feeling 
by  coarse  indelicacy,  family  affection  by  indifference  or  even  by 
hatred  and  malice.  The  delicate  and  refined  inhibitory  feelings, 
which  are  the  last  acquisitions  of  culture,  are  submerged  while 
the  storm  in  the  supreme  centres  lasts,  and  the  coarse  and 
deeper-rooted  impulses  of  the  animal  nature,  and  of  the  human 
nature  in  its  lower  relations,  come  to  the  front  and  dominate 
the  conduct.  One  sees  a  similar  illustration  of  this  early  para- 
lysis of  the  highest  inhibitory  functions  of  mind  in  the  tem- 
porary changes  which  an  alcoholic  excess  produces  in  the  moral 
characters  of  most  persons ;  for  moral  feeling  and  the  highest 
will  are  notably  weakened  at  an  early  stage  of  intoxication. 
And  just  as  it  is  with  the  person  who  is  not  too  far  gone  in 
intoxication,  so  it  is  with  the  insane  person  who  is  not  too  far 
gone  in  acute  mania ;  he  may  on  occasion  pull  his  scattered 
ideas  together  by  a  strong  effort  of  will,  stop  his  irrational 
doings,  and  for  a  short  time  talk  with  an  appearance  of  calm- 
ness and  reasonableness  that  may  well  raise  false  hopes  in  in- 
experienced persons.  It  is  a  deceptive  calm  ;  although  a  strong 
impression,  rousing  and  holding  the  attention,  will  balance  the 
mind  for  a  short  time,  the  turmoil  of  wild  and  whirling  ideas 
soon  recurs  and  is  expressed  in  an  answering  incoherent  volu- 
bility of  speech  and  endless  freaks  of  conduct.  All  the  while 
the  patient  knows  well  what  he  is  doing,  and  will  say,  after  his 
recovery,  that  he  was  quite  aware  of  the  consternation  which  he 


Mil.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  399 

caused,  but  had  an  indescribable  pleasure  in  yielding  to  his 
impulses  and  no  desire  whatever  to  check  them. 

There  is  probably  no  definite  and  abiding  delusion ;  an  idea  is 
no  sooner  conceived  than  it  is  either  discharged  in  action  or 
thrust  out  of  attention  by  another,  so  that  there  is  not  time, 
even  were  there  the  inclination,  to  examine  its  bearings  and  see 
that  it  is  a  true  idea.  Illusions  are  frequent,  the  patient  mis- 
seeing  oftentimes  what  he  sees ;  for  while  a  true  perception  is 
the  resultant  of  the  external  object  plus  the  fitting  idea,  it  is 
now  a  chance  what  idea  may  be  active  at  the  moment  when  the 
external  object  presents  itself  to  sense,  and  how,  therefore,  the 
object  is  interpreted.  Hallucinations,  too,  come  and  go,  for  the 
sensory  centres  of  the  excited  brain  are  stimulated  to  sensa- 
tions which,  as  in  dreams,  are  transformed  into  external  realities. 
Patients  will  imagine  that  they  hear  voices  address  them,  and 
will  answer  them  angrily ;  or  they  see  persons  who  have  no 
actual  existence,  or  more  commonly  they  declare  those  whom 
they  do  see  to  be  others  than  they  are;  or  they  smell  strange 
odours  and  taste  strange  substances  in  their  food ;  or  they  feel 
singular  pains  or  shocks  in  their  bodies,  which  they  attribute  to 
the  malignant  agency  of  enemies  who  are  playing  tricks  upon 
them.  There  can  be  no  doubt  also  that  some  have  motor 
illusions  and  hallucinations :  one  who  is  lying  in  his  bed  fancies 
perhaps  that  he  or  it  is  moved  upwards  or  downwards,  or  that 
his  limbs  are  flying  through  the  air  ;  the  disordered  motor 
centres  give  rise  to  the  sensations  of  such  movements,  and  these 
are  thereupon  imagined  to  be  real.  I  think  that  the  great 
restlessness  of  the  patient  who  frequently  cannot  remain  still 
for  a  minute  betrays  also  the  excitement  of  the  motor  centres ; 
for  he  seems  to  be  overpowered  by  veritable  impulses  to  be 
continually  on  the  move  without  having  definite  motives  for 
his  movements.  In  truth,  the  whole  nervous  mechanism  is  in 
a  disordered  commotion:  the  person  is  maniacal  to  the  ex- 
tremities of  his  nerves.  Therein  we  have  the  explanation  of 
the  facts  which  led  Pinel  to  think  that  the  primary  seat  of 
mania  was  usually  in  the  abdominal  organs,  and  that  the  intel- 
lectual disorder  was  propagated  thence  by  a  kind  of  irradiation ; 
appealing  in  support  of  his  opinion  to  the  voracious  and  capri- 
18 


400  PATHOLOGY  OF  MIND.  [chap. 

cioiis  appetite  and  to  the  abnormal  intestinal  sensations  which 
lead  to  the  drinking  of  large  quantities  of  water  or  of  other 
liquids;  to  the  restlessness,  sleeplessness,  agitation  and  panic 
fears;  to  the  disorder  and  confusion  of  ideas  shown,  not  in 
what  the  patient  says  and  does  only,  but  in  his  gestures, 
demeanour  and  aspect. 

The  following  example  of  ordinary  acute  mania  will  serve  to 
illustrate  what  I  have  said  concerning  its  symptoms : — A  mer- 
chant, of  some  originality  of  thought  and  of  much  energy  of 
character,  became  insane,  after  making  a  considerable  fortune 
entirely  by  his  own  abilities.  His  mother  had  died  insane. 
After  slight  depression,  followed  by  certain  speculative  trans- 
actions in  business  v^hich  rather  astonished  his  friends  as  being 
opposed  to  his  usual  cautious  manner  of  doing  things,  he  broke 
out  into  eccentricities  and  extravagances  of  behaviour,  with 
which  was  associated  an  unaccustomed  liveliness  ;  he  acted 
very  much  as  if  he  were  intoxicated,  turning  his  pictures  with 
their  faces  to  the  wall,  putting  chairs  in  queer  positions,  walk- 
ing about  the  garden  bareheaded  and  singing :  he  was,  indeed, 
singularly  elated,  talkative  in  a  rambling  way,  and  eccentricly 
and  aimlessly  industrious.  If  spoken  with,  he  was  lively, 
witty,  original,  and  satirical,  laughing  with  a  laugh  of  peculiar 
harsh  and  metallic  ring :  still  he  could  control  himself  for  a 
time,  assume  instantly  an  aspect  of  grave  deliberation,  and 
speak  with  a  marvellous  assumption  of  calmness  if  he  pleased. 
He  would  listen  to  advice,  appear  to  consider  it  deeply,  and 
perhaps  profess  to  approve  it ;  after  which  he  immediately  fell 
back  into  his  eccentricities.  There  was  so  far  much  more 
insanity  of  feeling  and  conduct  than  of  thought :  his  condition 
might  be  said  to  represent  an  acute  form  of  that  stage  of 
disease  which  has  already  been  described  as  the  mildest  form 
of  hereditary  insanity.  Degeneration  proceeding,  however,  he 
became  in  a  few  days  much  worse :  he  raved  incoherently  in 
conversation,  was  violent  in  action,  and  not  amenable  to  con- 
trol ;  his  language  was  obscene  and  disgusting,  his  behaviour 
not  less  so  ;  and  he  represented  very  completely  the  condition 
of  a  furious  maniac  whose  habits  were  of  the  worst  kind.  His 
tastes  were  depraved,  and  he  would  eagerly  seize  and  swallow 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  401 

the  filthiest  matters  ;  and  he  occupied  himself  husily  in  doing 
the  dirtiest  acts,  chanting  a  wild  chant  or  talking  in  rapid  in- 
coherence the  while.  In  the  worst  extremity  of  his  frenzy, 
however,  there  were  plain  indications  of  a  consciousness  of  his 
extravagances  and  a  capacity  to  control  his  actions  in  cer- 
tain regards,  which  could  not  fail  to  give  his  conduct  the 
semblance  of  a  witting  and  wilful  defiance  of  the  feelings  and 
opinions  of  those  who  had  to  do  with  him.  As  the  fury  of 
this  stage  somewhat  subsided,  various  delusions — as  that  he 
was  made  the  victim  of  medical  experiments  by  night  and  by 
day,  but  especially  by  night — were  exhibited  :  the  strange 
disease-produced  feelings  nowise  conforming  to  the  order  of 
his  previous  experience,  and  a  vague  feeling  probably  that  he 
was  the  agent  of  acts  not  truly  his  own,  were  interpreted  as 
the  results  of  external  malicious  agencies,  as  they  were  plainly 
not  wdthin  the  compass  of  his  knowledge  and  voluntary 
controL 

This  condition  of  things  lasted  for  more  than  a  week,  after 
which,  as  the  excitement  and  delusions  disappeared,  there  en- 
sued a  state  of  gloom  and  profound  moral  disturbance.  He  was 
possessed  with  a  great  hatred  of  all  his  friends;  was  sullen, 
morose,  and  gloomy ;  misrepresented  in  the  unfairest  way  every- 
thing which  had  been  done  to  control  him — and  he  had  an 
excellent  memory  of  what  had  been  done — as  deliberate  ciuelty; 
misinterpreted  any  kindness  or  act  of  attention  from  his  rela- 
tives ;  refused  his  food  or  took  it  most  capriciously ;  and, 
although  all  positive  delusions  seemed  to  have  vanished,  it 
was  plain  he  looked  upon  others  as  responsible  for  all  his 
sufferings  and  extravagances.  One  might  reason  with  him,  but 
even  if  he  acknowledged  the  justice  of  the  arguments,  which  he 
sometimes  did,  it  was  a  hypocritical  affectation ;  for  to  another  he 
would  immediately  afterwards  set  forth  his  unparalleled  griev- 
ances in  the  most  perverse  and  untrue  manner — more  untrue 
because  he  ingeniously  twisted  and  perverted  some  little  truth. 
When  well,  he  was  said  to  have  displayed  a  scrupulous  regard 
for  truth.  There  was  no  intellectual  incoherence :  he  told  his 
story  so  coherently  and  with  such  an  appearance  of  moderation 
in  his  complaints,  accusations,  and  statements  as  to  actually 


402  PATHOLOGY  OF  MIND.  [cuap. 

succeed  in  imposing  upon  an  influential  friend,  who,  himself  a 
most  honourable  man,  was  so  much  impressed  by  the  plausible 
way  in  which  he  accounted  for  all  his  peculiarities  as  conse- 
quences of  the  position  in  which  he  was  placed,  or  slurred  them 
over,  that  he  represented  in  the  strongest  possible  manner  to  his 
immediate  relatives  the  injustice  of  keeping  him  any  longer 
under  restraint.  Accordingly,  in  this  condition  of  imperfect 
convalescence — of  unquestionable  moral  or  affective  insanity — 
and  in  opposition  to  medical  remonstrances,  he  was  released 
from  restraint ;  all  the  people  in  his  neighbourhood  thinking  that 
he  had  been  most  unjustly  confined.  The  consequence  was  that 
in  the  course  of  a  few  weeks  he  so  managed,  or  rather  mis- 
managed, his  property — selling  stock  at  great  loss  and  giving 
away  large  sums  of  money  mider  the  most  absurd  pretences — 
as  to  afford  an  excellent  harvest  to  the  lawyers,  and  greatly  to 
impoverish  his  children.  It  was  found  necessary  to  place  him 
under  restraint  again.  The  event  proved  that  the  mania  was 
recurrent,  for  after  he  had  been  in  an  apparently  rational  state 
for  three  or  four  weeks  the  excitement  used  to  return  and  to  go 
through  exactly  the  same  course. 

In  this  case  then  we  note  a  short  period  of  unquiet  and  un- 
accountable depression  which  was  the  foreshadow  of  the  coming 
calamity  ;  quickly  followed  by  a  stage  of  so-called  exaltation,  in 
which  the  patient  seemed  to  be  in  an  exuberantly  happy  state, 
as  though  transported  with  some  joyful  tidings,  and  perpetrated 
various  extravagances  of  speech  and  action  as  though  from  an 
overflow  of  life.  Some  have  not  hesitated  to  describe  this 
condition  as  one  of  increased  mental  power  and  activity.  The 
real  state  of  the  patient  is  rather  one  of  irritable  weakness :  he 
is  unduly  impressible,  abnormally  excitable,  and  reacts  in  sudden 
impulses  of  feeling,  thought,  speech,  and  action,  which,  though, 
they  may  be  sometimes  brilliant,  more  resemble  spasms  than 
anything  else ;  he  is  entirely  unequal  to  a  calm  reception  and 
discrimination  of  impressions  and  a  subsequent  quiet  reflection 
and  final  intelligent  act  of  volition — to  that  complete  co-ordina- 
tion of  mental  function  which  is  implied  in  the  highest  mental 
activity.  The  condition  of  nerve  element  which  is  the  basis 
of  this  excitability  is  a  reaction  after  the  preceding  depression, 


viii.]  TPIE  SYMPTOMATOLOGY  OF  INSANITY.  403 

and  it  marks  the  beginning  of  a  degeneration  which,  if  not 
checked,  will  go  on  to  the  further  stage  of  positive  maniacal 
degeneration  of  mental  function — like  as  the  reaction  of  other 
kinds  of  organic  element  that  have  been  chemically  or  mechani- 
cally injured  passes  into  inflammation  and  purulent  degenera- 
tion :  it  is  a  state  of  instability  of  constitution  not  unlike  that 
which  is  the  condition  of  the  mildest  forms  of  hereditary  in- 
sanity, wdiere,  as  already  pointed  out,  striking  exhibitions  of 
particular  talents  occur  sometimes. 

Striking  in  this  case  w^as,  what  is  often  heard  in  other  cases, 
the  harsh  ring  of  the  strangely  altered  voice.  This  maniacal 
change  in  the  tone  of  voice,  which  is  apt  to  grate  on  the  sen- 
sibilities of  those  unaccustomed  to  hear  it,  testifies,  like  the 
deranged  thought,  perverted  sensibility,  and  furious  conduct,  to 
the  profound  and  general  disturbance  of  the  nervous  system. 
In  almost  every  disease,  but  especially  in  insanity,  there  are  a 
great  many  unobtrusive  and  almost  entirely  overlooked  symp- 
toms in  which  nature  speaks,  attention  being  fixed  on  a  few 
prominent  symptoms.  In  insanity,  for  example,  besides  the 
changed  tone  of  the  voice,  there  are  peculiarities  in  the  expres- 
sion of  the  countenance,  in  the  look  of  the  eye,  in  the  posture 
of  the  body,  constituting  the  physiognomy  of  the  disease,  wdiich 
deserve  exact  study.  Such  signs  may  show  whether  the  patient 
is  suicidal,  and  in  what  degree — whether  there  is  a  desperate 
impulse  that,  like  an  evil  fate,  governs  his  mind  and  waits  and 
watches  for  opportunities,  or  whether  a  fluctuating  impulse  is 
excited  to'  activity  by  opportunities.  Again,  there  are  great 
diversities  in  the  character  of  what  we  confound  under  the 
general  name  of  x^ain,  as  well  as  in  the  character  of  those  mani- 
fold modifications  of  sensibility  which  fall  short  of  pain,  so  much 
complained  of  in  some  forms  of  mental  disorder,  all  which  have 
their  specific  meanings  had  we  but  the  knowledge  to  interpret 
them.  Two  circumstances,  noteworthy  in  many  cases  of  in- 
sanity, were  marked  in  the  case  under  consideration:  these 
were  the  peculiar  indescribable  odour  of  the  patient — the 
houq^uet  de  malades  of  lunatic  wards — and  the  intensely  offen- 
sive character  of  the  intestinal  excretions.  Most  likely  there 
is  some  unknown  chemical  change  produced  in  the  excretory 


404  PAl'IIOLOGY  OF  MIND.  [chap. 

functions  by  the  profound  nervous  disturbance,  not  otherwise 
than  as  secretions  are  altered  in  composition  by  passion ;  the 
effect  attesting,  as  other  effects  just  mentioned  do,  the  essential 
interaction  of  the  mental  life  in  the  whole  bodily  life,  and  the 
impossibility  of  separating,  save  in  thought,  mental  and  bodily 
phenomena.  It  behoves  the  inquirer  therefore  to  carry  with 
him  to  the  investigation  of  every  case  of  insanity  a  deep  sense 
of  the  importance  of  scrupulously  studying  every  sign  of 
physical  disturbance,  motor,  sensory,  or  nutritive,  as  well  as 
the  prominent  mental  symptoms. 

The  third  stage  of  degeneration  exhibited  by  the  patient  was 
that  of  acute  maniacal  fury ;  of  which  it  is  not  necessary  to  say 
more  than  to  direct  attention  to  the  evidence  of  the  persistence 
of  a  certain  am.ount  of  self-consciousness,  and  to  the  occasional 
manifestation  of  a  certain  power  of  self-control  for  a  moment. 
This  is  the  more  necessary  because  of  the  ill-founded  criterion 
of  responsibility  sanctioned  by  English  law,  or  rather  by  Eng- 
lish lawyers.  Certainly  this  patient,  at  all  but  his  very  worst 
moments,  and  perhaps  even  then,  was  conscious  of  what  he  was 
doing  at  the  time,  as  he  had  an  exact  and  complete  memory  of 
it  afterwards,  and  was  quite  aware  that  it  was  disgusting  and 
offensive  to  those  around  him ;  he  had  even  some  power  of  self- 
control  at  times,  as  he  would  not  do  before  me  offensive  acts 
which  he  would  not  scruple  to  do  before  attendants;  so  that 
if  the  legal  criterion  of  responsibility  had  been  strictly  applied 
to  his  conduct,  he,  though  suffering  the  extremity  of  mania, 
ought  not  to  have  escaped  punishment.  As  the  frenzy  sub- 
sided and  delusions  appeared,  the  disease  becoming  more 
chronic,  we  might  say  that  a  fourth  brief  stage  was  passed 
through — a  stage  characterised  by  the  persistence  of  ideational 
disorder ;  that  is,  not  only  of  morbid  ideas,  but  of  the  morbid  asso- 
ciation of  ideas,  after  excitement  of  conduct  had  ceased.  From 
this  state  the  patient  soon  passed  into  a  well-marked  stage  of 
affective  insanity,  a  condition  which  usually  lasts  for  some  time 
after  ideational  disturbance  has  disappeared.  The  result  of  his 
premature  removal,  while  so  suffering,  affords  an  excellent  illus- 
tration of  the  truth  of  the  observation  of  Esquirol,  that  the  dis- 
appearance of  hallucination  or  delusion  is  only  a  certain  sign  of 


viii.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  405 

convalescence  wlien  there  is  a  return  to  tlie  natural  and  original 
affections.  To  this  moral  disorder  an  interval  of  apparent  sanity 
succeeded  before  the  supervention  of  a  new  attack. 

Now,  if  one  chose  to  suppose  each  of  the  stages  of  disease 
gone  through  by  this  patient  to  exist  separately  in  some  indi- 
vidual and  to  be  the  disease  in  him — to  conceive  in  fact  the 
progress  of  degeneration  through  generations  instead  of  through 
an  individual  life — then  one  might  form,  a  tolerably  correct  idea 
of  the  varieties  of  mania  that  are  met  with.  In  one  person 
the  fury  of  action  may  be  most  marked ;  in  another,  the  de- 
lirium of  thought,  chronic  or  acute ;  in  a  third  there  is  a  pre- 
dominance of  the  affective  disorder ;  and  according  to  the  pre- 
dominance of  one  or  other  of  these  characters  will  the  features 
of  the  variety  be  determined.  Eliminating  the  element  time  in 
considering  the  nature  of  mental  disease,  and  looking  upon  it 
as  a  degeneration  whose  course  may  be  through  generations  or 
within  the  compass  of  a  single  life,  we  shall  certainly  get  more 
correct  views  of  the  relations  which  the  different  forms  bear  to 
one  another;  a  morbid  phase,  which  would  barely  be  noticed  or 
might  be  entirely  passed  over  on  account  of  its  rapidity  and 
briefness  in  the  individual,  will  be  distinctly  evolved  and  repre- 
sented in  the  course  that  extends  through  generations ;  and  a 
phase  of  disease  which  might  have  too  great  importance  or  an 
independent  character  assigned  to  it  in  the  generation  will  re- 
ceive its  right  interpretation  by  a  consideration  of  the  course 
of  the  disease  in  the  individual.  Had  this  principle  been  at  all 
times  clearly  apprehended,  it  may  be  justly  questioned  whether 
any  one  would  have  been  found  to  doubt  or  misinterpret  those 
obscurer  forms  of  mental  disease  which  have  been  the  cause  of 
so  much  unprofitable  contention  and  angry  feeling. 

It  must  suffice  to  have  indicated  the  main  features  of  the 
differences  which  acute  mania  exhibits  in  different  patients, 
according  as  it  runs  more  in  a  motor,  or  ideational,  or  affective 
groove,  since  a  separate  description  of  them  would  be  a  long 
task  and  must  entail  a  great  deal  of  repetition.  But  there  is  one 
variety  of  acute  mania  which  is  very  like  the  delirium  of  acute 
disease,  and  claims  particular  notice.  It  is  really  an  acute 
delirium  rather  than  a  systematised  mania — the  d6lire  aigiie  of 


406  PATHOLOGY  OF  MIND.  [chap. 

Frencli  authors — and  is  characterised  by  great  excitement,  entire 
incoherence,  apparently  little  or  no  consciousness  of  what  is 
going  on  around,  extreme  restlessness,  and  violent  and  utterly 
unreasoning  resistance  to  treatment ;  the  course  of  the  disease 
being  swift  either  to  recovery  or  to  death.  The  following  ex- 
ample will  serve  to  illustrate  it : — 

A  cook  in  a  gentleman's  family,  whose  age  was  not  known, 
though  plainly  somewhere  between  forty   and  fifty,  was  rather 
suddenly   attacked  with  acute  mania.     Nothing  was  known  of 
her  previous  history,  but  she  had  been  considered  by  her  fellow- 
servants  to  be  a  little  peculiar,  and  she  had   suffered    from  a 
chronic  erysipelatous  inflammation  of  one  leg,  which  had  dis- 
appeared   a   short   time   before   her    attack   of   insanity.      She 
had  been  ill  seven  day  when  admitted  into  the  hospital,  and 
during  the  whole  of  that  time  had  been  noisy,  violent,  and  utterly 
incoherent;  and  she  had  taken  no  food  for  several  days.     On 
admission  her  state  was  one  of  extreme  delirious  mania  :  she  was 
noisily  incoherent,  stripped  off  her  clothes,  rolled  on  the  floor,  was 
unconscious  of  the  calls  of  nature,  and  seemingly  unconscious  also 
of  what  was  said  or  done  to  her ;  she  was  continually  spitting 
frothy  and  sticky  saliva,  and  her  countenance  w^as  haggard,  wild, 
and  painful  to  behold.     She  could  not  be  got  to  take  food,  and  it 
was  with  the  greatest  difficulty  that  beef-tea,  eggs,  and  brandy 
were  administered  to  her  at  frequent  intervals.      Morphia  made 
her  sick,  and  did  not  make  her  sleep.      This  went  on  night  and 
day  for  a  week,  when   she  was  reported  to  have  become  quiet ; 
but  it  was  the  quiet  of  complete  exhaustion.     Her  pulse  was  so 
feeble  and  rapid  that  it  could  not  be  counted,  though  up  to  the 
moment  of  the  collapse  she   had  been  as  excited,  noisy,  and 
restless  as  ever,  and  she  still  rolled  about  on  the  floor,  tossing 
her  arms  about  and  pulling  at  her  clothes.     Next  day  the  heart 
beat  feebly  160  times  in  a  minute,  so  far  as  could  be  made  out 
where  no  exact  examination  was  possible.     The  skin  was  hot 
and  dry ;  there  w^as  extreme  jactitation ;  and  she  drank  fluids 
eagerly,  as  she  had  never  done  before.     There  seemed  to  be 
some  abdominal  tenderness  on  pressure,  but  one  could  not  be 
sure  of  it.    Next  day  she  was  clearly  sinking  fast,  and  muttered 
words  which,  so  far  as  could  be  made  out,  were  a  request  for 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  407 

holy  water:    she   was    a   Eoman   Catholic.      Pressure   on   the 
abdomen  now  produced  evident  shrinking.      On  the  following 
day  she  died.     Though  the  issue  was  fatal  in  this  case,  it  is  not 
so  in  all  cases  of  acute  delirious  mania ;  it  is  however  a  disease 
of  the  gravest  omen,  because  of  its  liability  to   end   in  fatal 
exhaustion.      Whoever  asks  why  the  mania  should  take  this 
acute  delirious  form     what  peculiarity  of  individual  tempera- 
ment or  of  constitutional  state  is  the  cause  that  it  breaks  out 
rather  than  the  ordinary  systematised  mania — will  ask  in  vain. 
It  is  noteworthy  in  many  cases  of  mania  how  complete  and 
acute  is   the  memory  which  there  is  of   the  past  during  the 
attack,    and  of    all  that  has  happened  during  it  after   it  has 
passed  off ;  in  other  instances,  however,  the  thoughts,  feelings, 
and  events  of  the  paroxysm  are  only  remembered  indistinctly 
and  confusedly,  as  though  they  had  occurred  in  a  dream.     This 
persistence  of  memory  is  a  fact  which  it  is  well  for  those  to 
bear  in  mind  who  have  the  thankless  office  of  taking  care  of 
insane  persons,  since  an  impatient  utterance,  a  harsh  word  or 
act,  a  tone  of  ridicule,  a  sneering  remark,  a  look  of  disgust,  an 
angry  speech,  may  be  remembered  bitterly,  and  leave  a  sore 
feeling  in  the  mind  when  the  frenzy  has  passed  away.    However 
gi^eat  the   caution  used,  it  will  not  be  possible  in  every  case 
to  avoid  giving  offence,  for  the  patient,  confounding  persons  and 
things  with  his  delusions,  sometimes  imagines  those  who  have 
the  care  of  him  to  be  the  sole  cause  of  his  sufferings,  and,  after 
his  recovery,  fails  to  recognise  sincerely  the  true  nature  of  his 
frantic  doings,  which  he  will  extenuate,  excuse,  or  explain,  as 
having  been  provoked  by  the  iU  treatment  which  he  underwent. 
This  is  most  likely  to  happen  in  recurrent  mania  and  in  those 
cases  in  which  the  mental  disorder  is  a  pathological  intensifica- 
tion  of    a    selfish,    suspicious,    and   unamiable    character — the 
outcome,  in  fact,  of  ill-regulated  thought  and  feeling  fostered  by 
unwise  habits  of  life.     In  such  case  he  can  hardly  be  said  to 
have  been  actually  alienated  from  himself,  seeing  that  he  has 
not   been   radically  changed ;    it  is  no  wonder  therefore  that, 
although  seemingly  recovered,  he  does  not  heartily  acknowledge 
his  past  morbid  condition,  but   explains  his  insane  feeling  and 
conduct  as  natural,  and  contends  that  though  he  may  have  been 


408  PATHOLOGY  OF  MIND.  [rnxp. 

a  little  excited  there  was  no  insanity  in  it.  In  a  few  cases 
of  acute  mania,  especially  those  that  run  into  the  form  of 
delirium,  the  patient  forgets  altogether  the  events  of  his  mad- 
ness, like  as  a  dream  is  sometimes  forgotten.  A  second  or 
third  attack  of  mania  will  often  bring  hack  the  same  thoughts 
and  feelings  which  were  displayed  in  a  former  attack,  but  have 
been  latent  since,  so  that  even  attendants,  when  they  perceive 
them  coming  back,  know  well  that  an  outbreak  is  at  hand. 
Herein  we  note  a  resemblance  to  what  happens  in  epilepsy  when 
the  aura  forerunning  the  convulsions  is  the  recurrence  of  an 
idea  or  feeling,  or  the  vivid  recollection  of  an  event,  which  has 
uniformly  gone  before  the  fit  on  former  occasions. 

Looking  to  the  extreme  and  long  continued  agitation,  mental 
and  bodily,  and  to  the  loss  of  sleep  in  acute  mania,  the  bodily 
functions  suffer  less  seriously  than  might  be  expected.     In  the 
early  stage  the  pulse  is  perhaps  quicker,  but  this  is  owing  to 
the  muscular  exertions  rather  than  to  any  febrile  disturbance, 
and  it  is  afterwards  scarcely  accelerated.     The  temperature  of 
the  body  is  only  slightly,  if  at  all,  raised  in  ordinary  cases, 
except  when  it  is  hot  from  exertion ;  but  in  cases  of  a  typhoid 
type,  where  there  is  muttering  delirium  and  the  tendency  is  to 
death  from  exhaustion,  it  may  rise  from  three  to  five  degrees 
above  the  natural  standard.     In  the  insanity  occumng  during 
convalescence   from   acute   disease,  Dr.   Weber  found   only   a 
slight   increase   of   temperature,   although   it   had  been  raised 
considerably  during  the  acute  disease,  and  rose  again  directly 
in  those  cases  in  which  there  was  a  febrile  relapse.     When  it 
does  rise  notably  in  mania  there  is  just  reason  to  suspect  the 
supervention   of   some  other    disease   or   a  tendency   to   fatal 
exhaustion.     Notwithstanding    that  the    temperature  is  pretty 
nearly    normal,  it  is  plain  that  the  patient  has  oftentimes  a 
feeling   of   heat  or  of   bodily  discomfort  which  urges  him  to 
do  such  things  as  strip  off  his  clothes  in  the  daytime  ;  to  lie 
naked  at  night  on  the  floor ;  to  w^et  his  clothes  in  water  and 
wear  them  without  evincing  the  least  suffering  on  a  cold  day ;  to 
expose  himself  to  the  severest  weather  in  the  lightest  clothing. 
Moreover  he  does  not  suffer  in  health  from  this  sort  of  conduct 
while  animated  and  vigorous  at  the  beginning  and  at  the  height 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  409 

of  his  attack ;  but  although  he  continues  throughout  it  seemingly 
insensible  to  cold,  his  body  does  not,  since  he  may  be  attacked 
with  pneumonia  or  other  severe  disease  at  a  later  stage  when  his 
vigour  is  exhausted.  His  body  usually  becomes  thinner  and 
the  countenance  haggard  and  aged,  contrasting  so  much  perhaps 
with  its  natural  expression  that  he  would  hardly  be  known 
sometimes  for  the  same  person.  It  is  generally  pale  and  sallow, 
although  reddened  during  an  acute  paroxysm,  and  the  eyes  are 
wild,  bold,  sparkling,  sometimes  bloodshot,  and  at  the  same 
time  vacant  and  unsettled.  The  physiognomy — proud,  defiant, 
suspicious,  expansive,  or  expressive  of  some  other  passion — 
betrays  the  character  of  the  ideas  and  moods.  The  skin  is 
commonly  dry  and  harsh,  as  is  also  the  hair,  which  cannot 
easily  be  made  to  lie  smooth,  not  because  it  is  being  frequently 
rubbed  with  the  hands  only,  but  because  it  is  harsh  and  disposed 
to  stand  on  end.  It  sometimes  goes  rapidly  grey  during  an 
attack.  The  menstrual  function  in  women  is  usually  sup- 
pressed, but  not  in  all  cases. 

Acute  maniacs  do  not  commonly  refuse  food ;  they  eat  with 
voracity,  hastily,  and  without  discrimination.  It  is  plain  that 
their  tastes  and  organic  feelings  are  profoundly  vitiated,  since 
they  wiU  eagerly  devour  refuse  and  drink  the  most  unclean 
liquids.  Some  of  them  cannot  be  induced  to  take  food  :  either 
they  are  so  violently  delirious  that  they  are  insensible  to  the 
feeling  of  hunger  and  incapable  of  a  momentary  attention  ;  or 
they  suspect  its  nature  and  misconstrue  the  attentions  of  those 
who  offer  it ;  or  they  reject  it  in  direct  consequence  of  some 
such  delusion  as  that  they  are  exalted  beings  who  can  live 
miraculously  Avithout  food.  It  is  seldom  that  the  refusal  of 
food  is  persistent  in  acute  mania ;  for  the  delirium  abates  from 
time  to  time,  the  moods  change  rapidly,  the  delusions  come  and 
go  with  kaleidoscopic  transformation,  and  as  a  foul  tongue 
becomes  clean  and  gastric  disturbance  subsides  the  natural 
craving  for  food  comes  back.  They  will  mostly  take  it  there- 
fore at  one  time  when  not  at  another.  However,  those  who 
will  not  eat  must  be  fed  by  force  if  they  seem  likely  to 
persist  in  their  refusal :  first,  because  of  the  risk  which  they 
run    to   sink    from   exhaustion,   which    may  come    on    rather 


410  PATHOLOGY  OF  MIND.  [chap. 

suddenly  in  the  midst  of  a  fury  that  seemed  up  to  that  moment 
to  be  unabated ;  secondly,  because  the  downward  tendency 
is  to  dementia,  that  is  to  say,  to  exhaustion  and  destruc- 
tion of  mind  through  exhaustion  and  degeneration  of  nerve 
element — a  result  which  obviously  will  be  more  likely  to 
happen  when  the  bodily  strength  has  not  been  properly 
supported  during  the  paroxysm.  Divergent  and  contradictory 
statements  have  been  made  respecting  the  condition  of  the 
urine  in  this  as  in  other  forms  of  insanity,  some  observers 
having  professed  to  discover  an  excess  of  phosphates  in  it, 
which  they  have  thought  to  be  proof  of  an  abnormal  disintegra- 
tion of  nerve-tissue,  while  others  have  found  no  such  happy 
chime  of  fact  and  theory.  This  divergence  of  statement  need 
not  excite  surprise  when  we  reflect  that  in  some  cases  of  acute 
mania  there  is  positively  little  or  no  derangement  of  the  bodily 
functions  throughout ;  the  tongue  being  clean,  the  pulse  normal, 
the  digestion  strong,  and  the  sleep  fairly  good,  notwithstanding 
the  mental  turmoil. 

I  know  not  what  satisfactory  explanation  can  be  given  of  the 
fact  that  some  maniacs  are  able  to  keep  up  an  unceasing  activity 
so  long  as  they  do  with  little  or  no  sleep.  Certainly  some  of 
them  sleep  fairly  well  and  regularly,  being  wound  up  thereby 
to  greater  excitement  when  they  wake ;  others  shall  sleep  only 
on  alternate  nights,  and  they  are  oftentimes  more  excited  on  the 
day  after  a  good  night's  sleep  than  after  a  sleepless  night ;  but 
there  are  others  who,  continuing  their  turbulent  activity  day  and 
night,  hardly  seem  to  sleep  at  all.  It  is  easy  to  say  that  there 
is  an  excessive  production  of  nervous  energy,  the  exhaustion  of 
w^hich  in  ordinary  circumstances  occasions  sleep,  but  the  explana- 
tion does  not  carry  us  any  more  forward.  Excess  of  production 
means  excess  of  consumption;  expenditure  of  energy  must  be 
balanced  by  a  corresponding  supply  in  the  maniac  as  in  the 
steam-engine  ;  and  if  this  supply  in  him  is  procured  from  the 
blood  without  sleep,  where  is  the  necessity  of  sleep  in  order 
that  restoration  of  energy  may  take  place  in  a  person  who  is  in 
good  health  ?  Two  considerations  may  be  offered  as  fitted  to 
lessen  in  some  measure  the  seeming  strangeness  of  the  phe- 
nomenon,    Eirst,  we  ought  to  take  note  of  the  kind  of  energy 


vm.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  411 

displayed  by  the  maniac ;  it  is  the  large  and  explosive  outburst 
of  an  inferior  energy,  many  equivalents  of  which  are  needed  to 
balance  one  equivalent  of  the  higher  energy  of  a  calm  and  co- 
ordinated mental  and  bodily  activity  :  it  may  be  looked  upon  in 
fact  as  proceeding  from  the  decomposition  of  the  higher  energy. 
As  convulsion  is  not  strength  of  body,  so  mania  is  not  strength 
of  mind,  notwithstanding  that  several  men  cannot  hold  the 
person  who  is  writhing  in  the  one,  nor  reason  with  the  person 
who  is  labouring  in  the  other.  All  the  energies  of  the  being 
are  absorbed  in  the  disordered  activity  of  mind  and  body ; 
there  is  an  almost  entire  suspension  of  all  those  inhibitory 
functions  which  are  in  quiet  but  constant  use  by  a  sane  person, 
and  form  so  large  a  part  of  his  habitual  expenditure  of 
energy ;  and  the  consequence  is  that  there  is  a  gTeater  show 
of  excess  of  energy  than  there  really  is,  a  display  of  sound 
and  fury  which  does  not  signify  strength.  The  turbulent 
fury  and  weltering  ideas  are  the  outcome  of  an  inferior  grade 
of  nervous  functions,  the  highest  co-ordinating  functions  of 
the  mental  organisation  not  being  in  action  at  all.  Secondly, 
there  can  be  no  doubt  that  a  prolonged  mania  without  sleep 
does  in  the  end  produce  exhaustion  of  mind  and  some  weak- 
ness of  body,  though  less  soon  than  one  might  theoretically 
expect ;  in  most  cases  there  is  considerable  mental  prostration 
left  for  a  while  after  the  excitement  has  subsided,  and  in 
not  a  few  cases  permanent  mental  feebleness  is  the  result. 

Acute  mania  is  seldom  uniformly  progressive  in  its  course : 
there  are  great  variations  in  its  phases  as  well  as  in  its 
duration  in  different  cases.  Sometimes  it  quickly  reaches  its 
height,  like  a  thunderstorm,  and  continues  active,  with  scarcely 
notable  remissions,  up  to  its  termination.  Most  often  several 
longer  or  shorter  remissions  give  promise  of  convalescence 
wdiich  is  mocked  by  relapses  into  renewed  fury.  In  some 
instances  there  take  place  almost  complete  intermissions  or 
so-called  lucid  intervals ;  the  mania  recurring  perhaps  with 
singular  regularity  after  a  few  days  of  lucidity,  or  every 
month,  or  every  three  months,  or  once  or  twice  a  year,  and 
oftentimes  without  any  one  being  able  in  the  least  to  say 
why  it  should    thus   recur.     In   one   remarkable    case    which 


il2  PATHOLOGY  OF  MIND.  [chap. 

came  under  my  notice  a  lady  was  always  sane  one  day  and 
maniacal  the  next  day,  and  this  regular  alternation  of  states 
had  gone  on  for  several  months  when  I  saw  her.  Everything 
that  could  be  thought  of  was  tried  in  order  to  break  the 
chain  of  morbid  habit,  but  in  vain ;  on  every  other  day  she 
continued  to  wake  in  the  morning  sane  or  deranged  according 
as  it  was  the  turn  of  the  one  or  the  other  state. 

When  the  attacks  of  mania  are  separated  by  considerable 
intervals  of  sanity  it  is  called  periodic  or  recurrent,  and  the  out- 
look is  then  very  unfavourable.  Noteworthy  in  these  cases  is  the 
exact  repetition  which  one  attack  is  of  another :  the  person  be- 
comes unusually  elated,  talkative,  restless,  or  busily  mischievous  ; 
passes  thence  into  a  state  of  incoherence  and  greater  excitement 
marked  by  the  usual  symptoms  of  mania  which  lasts  for  two 
or  three  weeks  or  longer ;  and  then  sinks  into  a  brief  condition 
of  depression  or  confusion  of  mind  from  which  he  wakes  up 
to  lucidity :  after  a  sane  interval,  of  varying  length  in  different 
cases,  there  occurs  another  attack,  which  is  ushered  in  by  the 
recurrence  of  the  same  feelings  and  thoughts  that  went  before 
the  former  attack;  goes  through  the  same  phases  during  which  the 
same  sort  of  feelings  are  evinced  and  the  same  sort  of  insane 
acts  are  done,  and  ends  in  the  same  way — to  be  followed  in  due 
course  by  other  attacks,  until  the  mind  is  permanently  weakened 
and  the  lucid  breaks  that  occur  are  shorter  and  less  complete. 

Another  variety  of  mania  in  which  the  excitement  alter- 
nates with  periods  of  depression,  described  by  French  writers 
as  Folic  circidaire  or  Folic  a  douhlc  forme,  is  also  of  an  un- 
favourable character.  In  this  form,  as  in  the  recurrent  mania, 
the  phases  of  the  attacks  are  close  repetitions  of  the  phases  of 
former  attacks,  and  intervals  of  sanity  intervene  that  may  last 
for  a  few  weeks  only  or  for  years,  coming  either  after  the  excite- 
ment and  before  the  depression,  when  they  are  apt  to  be  short, 
or  more  often,  as  I  think,  after  the  depressed  stage,  when  they 
are  of  longer  duration.  Let  it  be  noted  in  these  cases  that  the 
excitement  generally  has  the  form  of  an  extreme  moral  elation 
and  alienation  rather  than  of  an  actual  intellectual  incoherence, 
and  that  the  depression  is  as  completely  opposite  a  state  of 
moral  prostration  and  self-distrust  as  it  is  possible  to  imagine. 


VII..]  THE  SYxMPTOMATOLOGY  OF  INSANITY.  413 

The  duration  of  acute  mania  is  very  variable :  it  is  for  a  few 
hours  or  a  few  days  only  in  occasional  instances,  for  a  few  weeks 
or  months  in  most  cases,  for  several  months  in  some  cases.  A 
transitory  mania,  mania  transitoria,  lasting  for  a  fev/  hours  only, 
and  terminating  perhaps  in  a  heavy  sleep  from  which  the  person 
wakes  calm  and  rational,  certainly  sometimes  follows  or  takes 
the  place  of  an  attack  of  epilepsy.  But  a  similar  passing  mania 
may  occur  where  there  is  neither  evidence  nor  suspicion  of 
epilepsy ;  it  has  followed  a  drunken  excess  now  and  then  ;  and 
I  have  known  two  instances  in  which  acute  mania  was  the 
result  of  the  moral  and  physical  excitement  of  the  first  night 
of  marriage,  in  one  of  them  passing  off  in  a  short  time.  Again, 
a  kind  of  acute  hysterical  mania  will  sometimes  come  on  in 
consequence  of  a  strong  moral  impression,  especially  if  the 
shock  be  coincident  with  some  functional  irregularity,  and  may 
pass  off  in  a  few  hours  or  days.  In  most  of  these  cases  of 
transitory  mania  it  will  be  found  on  inquiry  that  there  was  a 
decided  predisposition  to  mental  disorder ;  and  the  brief  storm, 
though  it  has  happily  passed  quickly  this  time,  may  justly  raise 
apprehension  for  the  future.  The  duration  of  acute  mania  is 
under  three  months  or  under  six  months  in  most  cases  where 
recovery  takes  place;  it  may  be  prolonged  by  the  remissions 
which  are  so  common  in  its  course  to  nine  months  or  a  year  and 
still  end  in  recovery ;  but  when  it  has  lasted  beyond  nine  months 
or  a  year  the  prognosis  is  very  bad.  The  longer  the  disease 
lasts  the  worse  generally  is  tiie  prognosis,  which  is  always  bad 
in  the  recurrent  form,  whether  the  attacks  are  short  or  lonor. 

It  may  be  truly  said  that  nearly  half  the  cases  of  simple 
acute  mania  get  well  if  placed  under  proper  treatment  in  good 
time ;  but  the  longer  suitable  measures  of  treatment  are  put  off 
the  worse  becomes  the  prospect  of  recovery.  The  return  of 
reason  is  foretokened  by  the  steady  waning  of  the  excitement ; 
by  the  discontinuance  of  senseless  acts ;  by  a  shrinking  from 
noisy  parleys  which  before  were  courted ;  by  an  increasing  co- 
herence of  talk ;  by  a  reviving  sense  of  decency  and  propriety ; 
by  less  disregard  of  dress  and  demeanour ;  by  an  occasional 
curious  or  anxious  inquiry  about  friends  or  affairs,  or  by  some 
other  rational  question ;   and  in  some  instances  by  periods   of 


414  PATHOLOGY  OF  MIND.  [chap. 

depression.     It  is  an  excellent  omen  when  the  patient  begins  to 
recognise  that  he  has  been  ill  and  is  depressed ;  a  bad  sign,  as 
foreboding  relapse,  when  he  is  much  elated,  exultantly  talks  of 
his  perfect  recovery,  and  ignores  his  serious  illness.      When  the 
mania  is  entirely  past  a  patient  sometimes  falls  into  a  state  of 
apathetic  depression  which   looks   like    fatuity   and  occasions 
alarm ;  he  seldom  speaks,  betrays  confusion  of  mind  and  im- 
paired memory  when  he  does,  is  without  the  least  energy,  and 
evinces  little  or  no  interest  in  anybody  or  anything :  it  is  not, 
however,  a  state  of  true  dementia,  but  a  temporary  prostration, 
and  the  mental  power  may  be  regained  by  degrees  as  the  ex- 
haustion following  the  mental  storm  is  recovered  from.     One 
sees  a  similar  effect  after  the  acute  delirium  produced  by  a 
seriously  poisonous  dose  of  Datura  stramonium  has  disappeared  ; 
apathy  and  confusion  of  mind  and  great  impairment  of  memory 
remain,  which  are  not  recovered  from  for  some  days.    In  like 
manner  the  effects  of  the  delirium  of  typhus  fever  are  some- 
times evident  for  a  considerable  time  in  a  damaged  memory. 
The  return  of  an  accustomed  discharge,  healthy  or  morbid,  such 
as  the  menses,    or   a  leucorrhoeal,  hsemorrhoidal,  or  bronchial 
discharge,  wdiich  has  been  suspended  during  the  paroxysm  of 
mania ;  or  the  recurrence  of  a  neuralgia,  of  an   asthma,  or  of 
some  other  wonted  bodily  suffering  from  which  the  patient  has 
been  free  during  his  derangement — not  unfrequently  accompanies 
the  return  to  a  right  mind. 

When  recovery  does  not  take  place  the  disease  either  declines 
into  a  chronic  mania  or  dementia ;  or  it  is  followed  by  an  attack 
of  melancholy  and  enters  upon  the  bad  circle  of  a  so-called 
folie,  circulaire ;  or  it  ends  fatally.  Death  is  most  often  the 
result  of  exhaustion,  but  it  may  be  due  to  some  intercurrent 
and  rapidly  spreading  disease  such  as  pleurisy,  pneumonia,  peri- 
tonitis, erysipelatous  inflammation  and  sloughing  of  some 
wound.  When  maniacal  exhaustion  proves  fatal  the  end  is 
sometimes  sudden  and -unexpected,  leaving  in  the  mind  an 
anxious  feeling  of  doubt  whether  a  more  energetic  treatment 
might  not  have  prevented  death,  or,  if  sedatives  have  been  given 
largely,  whether  they  have  not  helped  to  hasten  the  fatal  issue. 
More  often  after  continuing  in  a  state  of  unabated  frenzy  for 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  416 

some  time,  the  patient  suddenly  collapses,  not  dying  immedi- 
ately, but  tossing  about  in  a  feeble  and  prostrate  state,  with 
quick  and  hardly  perceptible  pulse  and  inability  to  take  food, 
until  he  sinks  gradually  from  exhaustion.  1  have  never  seen  in 
these  cases  a  return  of  reason  before  death,  such  as  novelists  are 
apt  to  depict  in  their  so-called  brain-fevers,  but  I  have  noticed 
sometimes  a  little  more  consciousness  of  their  surroundings 
before  the  end  than  was  ever  shown  during  the  frenzy. 

When  acute  mania-  has  declined  into  a  chronic  mania,  the 
latter  exhibits  varied  features  according  to  the  degree  and  extent 
of  mental  degeneration.  If  the  general  disease  has  localised 
itself  in  a  part  of  the  mental  organisation,  leaving  the  rest  of  it 
comparatively  free  from  disorder — not  otherwise  than  as  a  general 
disturbance  of  nutrition  localises  itself  in  a  particular  morbid 
growth — there  are  delusions  limited  to  one  class  of  subjects,  apart 
from  which  the  patient  for  the  most  apprehends,  feels,  reasons, 
and  acts  like  the  rest  of  mankind ;  the  case  then  falls  under 
the  head  of  monomania  or  'partial  mania.  AYhen  there  is  a 
greater  loss  of  mental  power,  together  with  delusions  and  general 
incoherence,  the  morbid  action  implicating  the  whole  of  the 
mental  organisation  in  a  chronic  form,  as  is  more  likely  to 
happen  when  the  primary  attack  has  been  produced  by  a 
physical  cause  or  has  lasted  long  in  a  feeble  mental  constitution, 
the  case  may  be  referred  to  chronic  mania  or  to  one  of  the 
groups  of  dementia.  For  the  difference  between  chronic  mania 
and  dementia  is  only  a  difference  of  degree  of  mental  disorgani- 
sation, and  examples  perpetually  occur  that  render  it  impossible 
to  make  a  definite  line  of  division  between  them.  At  the  one 
end  then  chronic  mania  has  the  partial  or  circumscribed  char- 
acter of  a  so-called  monomania ;  at  the  other  end  it  passes 
insensibly  into  dementia. 


Monomania. 

The  best  examples  of  partial  ideational  insanity,  so-called, 
are  undoubtedly  furnished  by  those  cases  of  melancholia  in 
which  the  mind  labours  under  a  particular  delusion  of  a  gloomy 


416  PATHOLOGY  OF  MIND.  [chap. 

nature  and  is  in  other  respects  singularly  rational — those  cases, 
in  fact,  to  which  Esquirol  gave  the  name  of  Lypemania,  in 
order  to  distinguish  them  from  the  cases  of  partial  intellectual 
derangement  in  which  the  inspiring  passion  was  of  an  elated  or 
expansive  nature.  To  these  last  it  is  that  the  term  monomania 
is  now  limited  by  custom,  the  former  class  being  described 
under  chronic  melancholia;  and  it  is  with  them  that  I  am 
concerned  now. 

In  the  outset  it  is  proper  to  point  out  that  Esquirol,  who 
first  used  the  word  monomania,  applied  it  to  three  different 
classes  of  symptoms  of  incomplete  mental  derangement :  to 
those  which,  now  commonly  known  in  this  country  as  cases  of 
moral  insanity,  he  designated  •monomanie  affcctin)e ;  to  those 
which,  described  by  me  in  a  previous  chapter  under  the  head 
of  im^mlsive  or  instinctive  insanity,  he  called  monomanie  in- 
stinctive or  monomanie  sans  delire ;  and  to  those  which  I  have 
to  deal  with  now,  and  which  he  distinguished  as  monomanie 
intellectuelle. 

Although  this  intellectual  monomania  is  often  secondary  to 
acute  mania,  it  is  not  so  in  all  cases  ;  sometimes  it  is  a  primary 
derangement  which  has  been  developed  by  degrees  as  an 
exaggeration  of  a  fundamental  fault  of  character.  A  vain  and 
aspiring  person,  for  example,  whose  pretensions  far  outrun  his 
powers,  or  in  whom  the  pride  of  some  natural  powers  has  been 
nursed  by  success  and  flattery,  may  grow  into  the  delusive 
belief  that  he  is  a  prophet,  an  emperor,  a  great  discoverer,  or 
some  other  extraordinarily  distinguished  character,  without  ever 
having  had  an  attack  of  acute  mania,  i^ny  one  who  reads  with 
competent  insight  the  history  of  Edward  Irving,  so  distinguished 
as  a  preacher  in  the  early  part  of  his  career  in  London,  cannot 
fail  to  perceive  that  the  mental  derangement  in  which  it  ended 
was  the  natural  and  inevitable  morbid  outcome  of  his  character 
in  the  fostering  circumstances  in  which  it  w^as  placed.  Tlie 
lesson  of  Swedenborg's  life  is  perhaps  still  more  instructive; 
the  son  of  a  father  wliose  placid  assurance  of  his  own  singular 
worth  was  remarkable,  he  dis^Dlayed  from  the  earliest  period 
of  his  intellectual  activity  a  serene  and  boundless  self-suffi- 
ciency, undertaking  without  the  least  hesitation  or  self-restraint 


vui.]  THE  SYiMPTCMATOLOGY  OF  INSANITY.  417 

the  most  difficult  problems  of  scientific  speculation  in  mag- 
netism, in  chemistry,  in  astronomy,  in  anatomy,  in  any  other 
subject,  and  solving  them  to  his  own  satisfaction  with  a  self- 
confidence  incapable  of  doubt ;  and  the  period  of  his  life  when 
he  relinquished  all  scientific  studies  and  worldly  learning,  de- 
voting himself  to  the  sacred  office  to  which  he  believed  the  Lord 
Himself  had  called  him,  "  who,"  he  says,  "  was  graciously 
pleased  to  manifest  Himself  to  me,  His  unworthy  servant,  in  a 
personal  appearance  in  the  year  1743;  to  open  in  me  a  sight  of 
the  spiritual  world,  and  to  enable  me  to  converse  with  spirits 
and  angels," — was  coincident  with  what  was  evidently  an  attack 
of  acute  mania.  When  the  acute  attack  passed  away  a  mono- 
mania was  left  behind  which  was  the  morbid  evolution  of  his 
self-sufficient  character;  and  thenceforth  he  occupied  himself 
in  intercourse  with  the  spirits  of  heaven  and  of  hell,  and  in 
recording  the  revelations  which  he  received,  declaring  calmly 
and  seriously  that  through  him  the  Lord  Jesus  Christ  had  made 
his  second  advent  for  the  institution  of  a  new  church  described 
in  the  Eevelation  under  the  figure  of  the  New  Jerusalem.^ 

There  is  no  large  asylum  for  the  insane  in  which  patients  will 
not  be  found  who  imagine  themselves  to  be  kings,  princes,  great 
lords,  or  other  highly  placed  personages ;  who  nevertheless  con- 
verse sensibly  on  all  subjects  that,  being  outside  the  sphere  of 
their  delirium,  do  not  stir  their  morbid  trains  of  thoufjht,  and 
who  behave  themselves  with  habitual  propriety.  It  may  be  a 
hard  matter  to  elicit  from  some  of  them  in  conversation  any 
evidence  of  derangement  if  they  have  a  motive  to  conceal  it ; 
and  they  are  quite  able  sometimes  to  exercise  self-control  enough 
to  do  that  successfully  for  a  time.  Others  believe  themselves  to 
be  in  direct  communication  with  God  or  with  anijels,  and  re- 
ceive  messages  which  they  write  down  and  deliver  or  address  to 
their  medical  attendants,  always  spealdng  with  the  same  quiet 
or  energetic  assurance  on  these  matters  when  they  are  touched 

•  I  may  refer  for  a  fuller  exposition  of  the  character  of  his  derangement 
to  my  essay  on  Swedenborg  in  Body  and  Mind,  second  edition.  It  has 
provoked  violent  criticisms  and  angry  letters  from  some  of  his  disciples. 
I  am  sorry  to  have  hurt  their  feelings,  but  until  the  evidence  of  his  own 
jyiary  be  proved  false,  I  cannot  alter  my  opinion. 


418  PATHOLOGY  OF  MIND.  [chap. 

upon,  and  evincing  no  unsoundness  in  ordinary  conversation  on 
other  subjects.  All  these  people,  however,  are  easily  irritated 
by  contradiction  of  their  claims  or  by  arguments  against  them ; 
their  faces  then  flush,  their  eyes  sparkle,  they  become  passion- 
ately energetic  and  denunciatory  and  perhaps  actually  inco- 
herent in  their  language,  and  it  may  be  some  time  before  they 
forgive  the  offence  done  to  their  dignity. 

I  am  acquainted  with  a  gentleman,  the  inmate  of  an  asylum, 
who  has  the  delusion  that  he  is  Jesus  Christ ;  he  mixes  little 
with  other  patients ;  seldom  speaks  except  when  addressed,  when 
he  a.nswers  intelligently  and  wdth  great  courtesy ;  walks  in  a  re- 
tired part  of  the  grounds  with  a  calm  dignity  that  arrests  notice, 
dressing  with  scrupulous  care  and  wearing  a  long  white  beard ; 
and  never  gives  utterance  to  any  insane  ideas  that  are  not  ex- 
tracted from  him  by  close  questionings.  At  one  time  his  wife, 
having  wished  for  his  discharge,  had  him  visited  and  examined 
by  two  eminent  physicians,  who,  after  a  long  conversation  with 
him,  could  find  no  insanity  in  him  and  recommended  his  dis- 
charge. This  was  not  granted  by  the  authorities, — first,  because 
he  had  been  sent  to  the  asylum  in  the  first  instance  in  conse- 
quence of  his  having  struck  a  cabhorse  violently  on  the  head 
with  an  axe  as  he  drove  past  it,  and  this  he  had  done  in  order 
to  obtain  a  public  trial  and  so  enforce  the  world's  attention  to 
his  claims ;  and,  secondly,  because  it  was  certain  that  notwith- 
standing the  failure  of  the  eminent  physicians  to  detect  his  de- 
lusion he  was  still  as  firmly  convinced  that  he  was  Jesus  Christ 
as  he  ever  had  been.  In  fact,  he  has  never  abandoned  the 
belief,  to  which,  his  mind  being  weaker,  he  now  gives  utter- 
ance more  readily  than  formerly.  Moreover,  it  is  apparent  now, 
when  a  real  examination  of  his  mental  state  is  made,  that  the 
infection  of  his  main  delusion  has  spread  into  much  secondary 
delusion  of  thought.^ 

*  Dr.  Hood,  formerly  Supenntetident  of  Betlileliem  Hospital,  had  a  pa- 
tient there  who  had  been  sent  to  the  asylum  for  annoying  the  Queen  in 
Eotten  Eow.  He  had  been  twenty  years  in  confinement,  during  the  last 
fifteen  of  which  he  had  not  presented  any  symptom  of  his  particular  delu- 
sions, nor  during  eight  of  them  any  symptom  of  insanity.  After  perse- 
vering efforts  Dr.  Hood  obtained  his  discharge.  Five  months  afterwards 
he  received  a  letter  from  Lord  Palmerston,  asking  if  he  was  aware  that 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  419 

Were  the  most  experienced  physician  asked  to  say  beforehand 
what  cases  of  mania  were  likely  to  end  in  monomania,  T  doubt 
Avhether  he  would  be  able  to  answer  the  question  satisfactorily 
in  any  case.  This  much  he  might  say — that  a  person  of  moderate 
self-esteem,  regulated   temper   and   desires,   habitual  self-com- 
mand, who  had  the  misfortune  to  be  driven  maniacal  by  some 
powerful  exciting  cause,  would  not  fall  into  monomania  after 
the  acute  paroxysm ;  and  that  he  who  would  be  most  likely  to 
do  so  would  be  one  in  whose  character  some  exaggerated  passion 
of  an  egoistic  nature,  such  as  pride,  ambition,  envy,  had  been 
fostered  before  the  attack — in  whom,  in  fact,  the  madness  was 
not  something,  as  it  were,  extrinsic  and  accidental,  but  intrinsic 
and  essential.      It  will  be  noticed  in  some  instances  that  the 
patient  who  begins  with  a  doleful  delusion  that  he  is  the  victim 
of  a  persistent  and  mysterious   persecution  ends  by  imagining 
himself  to  be  some  very  great  personage,  and  the  persecutions 
which  he  undergoes  to  be  done  to  him  on  that  account ;  he  can- 
not conceive  that  so  many  mysterious   signs  should  be  made 
wherever  he  goes,  or  that  so  much  trouble  should  be  taken  to 
do  him  hurt  and  mischief,  unless  he  is  a  person  of  far  greater 
consequence  than  it  is  pretended  he  is ;  and  he  grows  perhaps 
to  the  notion  that  he  is  of  royal  descent  and  has  been  deprived 
of  his  birthrights  by  an  extraordinary  conspiracy.     It  is  a  quasi- 
logical  explanation  of  the  primary  delusion,   a  pathologically 
losjical  evolution  of  it. 

I  think  it  will  be  noticed  again  that  the  most  characteristic 
examples  of  monomania  are  commonly  met  with  in  persons 
who  have  a  decided  insane  inheritance;  for  it  is  in  them 
certainly  that  we  find  an  outrageously  extravagant  delusion  or 
the  strangest  conduct  coexist  quietly  side  by  side  with  a  degree 
of  reason  that  could  not  fail,  it  mioht  be  thought,  to  correct  it. 
The  individual  embodies  in  his  constitution  the  insanity  of 
previous  generations  which,  when  it  comes  out,  coming  out  as 
a  sort  of  natural  evolution,  is  accentuated  in  character,  self- 
sufficient  and  self-dependent,  neither  requiring  the  support  nor 

such  a  man  was  at  large,  and  sending  three  or  four  letters  to  the  Queen, 
which  he  had  received  from  the  patient,  asking  for  the  hand  of  the  Princess 
Alice.  He  was  really  as  insane  as  ever  he  had  been,  and  had  delusions 
of  the  same  kind  as  he  had  twenty  years  before. 


420  PATHOLOGY  OF  MIND.  [chap. 

susceptible  to  the  criticism  of  adjacent  mental  functions,  which, 
on  their  part,  are  not  greatly  disturbed  by  it.  What  wonder 
indeed  that  it  does  not  seem  very  strange  to  the  reason  whose 
potent  alities  have  **lain  in  the  same  egg"  with  it  through 
successive  generations!  Of  notable  eccentricities  of  thought 
and  conduct  which  cause  it  to  be  said  off-hand  of  the  person 
who  displays  them  that  he  must  be  mad,  one  hears  it  remarked 
sometimes  that  they  do  not  mean  madness  in  him,  and  need  not 
be  taken  notice  of  as  if  they  were  of  any  consequence,  be- 
cause he  comes  of  a  peculiar  family  who  have  ahvays  been 
accustomed  to  think  and  to  do  some  very  odd  things ;  and  it  is 
quite  true  that  eccentricities  of  thought  and  conduct  which 
would  be  ominous  signs  of  madness  in  a  person  who  had  no 
such  peculiar  inheritance  and  would  certainly  portend  a  grave 
ultimate  issue  may  continue  in  him  unto  the  end  of  his  days 
side  by  side  with  a  lucidity  of  reason  in  other  respects  with 
which  they  might  seem  utterly  incompatible,  and  without 
causing  further  derangement.  The  most  typical  example  of 
monomania  is  only  an  extremer  illustration  of  this  character 
of  hereditary  insanity.  Lastly,  it  will  be  noticed  that  mono- 
mania is  apt  to  occur  in  some  weakminded  persons  whose 
intelligence,  if  not  actually  defective  enough  to  constitute  them 
imbeciles,  is  of  a  low  order  and  has  been  little  cultivated ;  for 
a  weak  strain  of  intense  vanity  commonly  goes  along  with  a 
feeble  intellect  both  in  idiot  asylums  and  outside  them. 

The  course  of  monomania  is  not  often  towards  recovery.  The 
reasons  are  plain :  in  the  first  place,  when  it  is  secondary  to 
mania  or  melancholia  it  signifies  a  chronic  morbid  nutrition 
which  is  a  further  stage  of  degeneration  of  the  delicate  organi- 
sation of  mind ;  in  the  second  place,  wdien  it  is  primary,  it  is 
the  morbid  outgrowth  of  a  fundamental  quality  of  character,  so 
that  to  get  rid  of  it  would  be  to  undo  the  very  character  from 
its  foundations.  Nevertheless,  there  is  occasionally  a  recovery 
under  the  influence  of  a  steady  and  systematic  moral  discipline 
or  in  consequence  of  some  great  shock  to,  or  change  in,  the 
system — whether  a  shock  of  an  emotional  character,  such  as 
the  announcement  of  the  sudden  illness  or  sudden  death  of 
one  who  was  most  near  and  dear ;  or  a  change  in  the  system 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  421 

produced  by  some  intercurrent  severe  bodily  disease  of  an  acute 
character,  which,  having  just  missed  being  fatal  to  life,  has 
restored  the  reason  ;  or  the  great  bodily  change  which  takes 
place  naturally  in  women  at  the  climacteric  period.  I  have 
known  recovery  to  take  place  in  each  of  these  circumstances. 
I  call  to  mind  in  particular  the  case  of  a  gentleman  who  had 
laboured  under  a  long-standing  delusion  of  a  gloomy  nature, 
which  was  thought  to  be  fixed  and  never  likely  to  leave  hira^ 
but  who  recovered  in  consequence  of  a  severe  attack  of  pleurisy 
which  necessitated  the  tapping  of  the  chest  and  the  subsequent 
insertion  of  a  drainage  tube  for  some  time.  When  recovery 
does  not  take  place  the  mind  is  apt  to  get  slowly  weaker,  and 
the  disease  so  to  decline  into  dementia :  the  more  the  exagfj^er- 
ated  self-feeling  which  underlies  and  inspires  the  delusion  wanes, 
and  the  more  this,  losing  the  inspiration  which  gave  a  sort  of 
unity  and  coherence  to  its  manifestations,  becomes  a  mere 
form  of  words,  the  more  plainly  the  patient  sinks  into  an  in- 
coherent dementia.  Eecovery  is  at  all  times  more  likely  to 
take  place  in  this  chronic  insanity  when  the  delusion  is  gloomy 
than  when  it  is  exalted  ;  in  the  former  case  the  derangement  is 
more  extrinsic  in  its  origin,  the  system  evinces  its  suffering,  is 
depressed  thereby  and  sensible,  so  to  speak,  of  the  need  of 
amendment,  while  in  the  latter  case  the  malady  is  more  intrinsic 
in  its  origin,  the  system  is  abundantly  satisfied  with  its  condi- 
tion, exalted,  and  not  sensible  of  anything  to  amend. 

For  the  most  part  there  is  more  derangement  than  appears  on 
the  surface  in  any  case  of  monomania,  however  circumscribed 
the  range  of  the  delusion  may  seem  to  be,  and  one  may  feel 
pretty  sure  that  the  application  of  a  sufficient  test  will  discover 
it  at  one  time  or  another.  Hallucinations  of  sense,  especially  of 
hearing,  exist  sometimes  when  not  suspected.  The  faculties  of 
the  mind  are  not  independent,  but  work  together  in  a  vital 
harmony,  so  that  when  a  part  suffers  the  whole  suffers  more 
or  less  with  it :  when  an  insane  delusion  persists  in  spite  of 
evidence  of  its  absurdity  it  is  proof  that  the  whole  mind  is 
overpowered  or  weakened  and  cannot  exert  upon  it  that  con- 
trolling and  corrective  influence  which,  were  it  sound  and  strong, 
it  would  not  fail  to  do.     If  a  person  who  has  hitherto  lived  on 


422  PATHOLOGY  OF  MIND.  [chap. 

the  best  possible  terms  with  his  wife,  loving  and  trusting  her 
entirely,  conceives  the  insane  idea,  without  the  least  reason  in 
fact,  that  she  is  dishonouring  him  by  adulterous  intercourse 
with  other  men,  the  very  existence  of  a  delusion  so  foreign  to 
the  whole  habit  of  his  healthy  thought  and  feeling  marks  a  deep 
and  general  derangement  of  mind,  notwithstanding  an  appear- 
ance of  entire  sanity  in  all  other  matters,  and  it  will  be  impos- 
sible to  foresee  the  influence  it  may  have  eventually  upon  his 
thoughts  and  upon  his  conduct.  Locke's  description,  so  often 
quoted,  of  the  lunatic  as  a  person  who  reasons  correctly  from 
false  premises  is  a  notion  of  the  closet,  not  one  that  is  founded 
on  experience.  The  monomaniac  is  far  from  deducing  the  logi- 
cal consequences  from  his  delusions  and  acting  in  accordance 
with  them  ;  he  deduces  not  logical  but  pathological  conclusions; 
the  same  lack  of  reason  which  is  shown  in  the  existence  of 
the  delusion  in  his  mind  is  shown  in  irrational  inferences, 
in  incoherent  ideas,  and  in  inconsistent  conduct.  Accepting  the 
premises  of  his  delusion  and  reasoning  correctly  from  them,  a 
sound  understanding  could  not  foretell  what  he  will  think  and 
do.  It  is  strange,  however,  how  long  an  extravagant  delusion 
may  co-exist  with  apparent  sanity  on  all  matters  outside  its 
range  in  a  person  who  has  a  decided  insane  mental  heritage ;  in 
whom,  in  fact,  there  is  a  natural  tendency  to  a  want  of  harmony, 
or  to  a  sort  of  dislocation  or  discontinuity,  of  mental  functions. 
When  the  monomaniac,  so-called,  comes  under  the  observa- 
tion of  one  who  is  not  only  competent  to  observe,  but  has  suffi- 
cient opportunities  to  do  so,  it  will  commonly  be  found  that 
there  is  a  bluntness  or  loss  of  his  natural  affection  and  social 
feelings  in  consequence  of  his  being  so  entirely  centred  in  his 
morbid  self;  that  his  character  and  habits  have  undergone  some 
change ;  and  that  he  exhibits  an  excitability  of  mind  with  loss 
of  self-control  in  circumstances  which  would  not  formerly  have 
provoked  it.  His  mind  generally  is  in  that  condition  of  dis- 
turbed moral  tone  in  which  unforeseen  whims  and  feelings  and 
impulses  are  apt  to  start  into  spasmodic  activity  abruptly.  What 
is  sufficiently  remarkable  too  is  that  when  a  patient  of  this  kind 
is  placed  in  an  asylum,  instead  of  being  surprised  at  his  position, 
and  distressed  by  what  he  sees  around  him,  as  so  seemingly  sane 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  423 

a  person  miglit  be  expected  to  be,  he  adapts  himself  to  his  new- 
surroundings  with  remarkable  equanimity  and  as  if  he  had  lived 
in  them  all  his  life  ;  moreover,  he  evinces  little  or  no  anxiety  to 
know  why  he  is  there,  or  how  he  is  to  get  away,  and  an  imper- 
fect appreciation  of  the  derangement  of  the  other  patients.  Inside 
the  asylum,  where  his  life  is  ordered  in  a  quiet  and  regular  way, 
and  there  is  no  strain  upon  his  mental  resources,  he  will  go  on 
calmly  from  day  to  day  and  from  week  to  week  without  any 
outbreak  of  excitement ;  but  if  he  be  at  large  in  the  world,  free 
to  follow  his  own  devices  and  exposed  to  occasions  of  excite- 
ment, then  he  is  likely  to  show  paroxysms  of  unreason  and 
even  outbursts  of  dangerous  frenzy.  It  is  surprising  what 
extreme  unreason  and  incoherence  on  these  occasions  may  be 
exhibited  sometimes  by  one  whose  general  manner  and  conver- 
sation would  not  be  thought  to  forebode  anything  of  the  sort. 

During  the  Franco-German  war,  when  Paris  was  being  besieged. 
Dr.  Foville  noted  the  eiFects  of  the  commotion  upon  some  pa- 
tients in  his  asylum  whose  insanity  was  of  the  partial  sort  which 
is  usually  described  as  monomania ;  and  the  result  was  to  dis- 
credit strongly  in  his  mind  the  theory  of  a  partial  lesion  of 
the  understanding.  One  patient,  who  read  the  newspapers 
regularly,  and  appeared  to  follow  the  events  of  the  war  intel- 
ligently, declared  nevertheless  that  he  was  not  fool  enough  to 
be  taken  in  either  by  the  accounts  which  he  read  or  by  the 
incessant  roar  of  the  artillery  which  he  heard  ;  he  afQrmed  that 
all  the  noise  was  produced  by  some  fools  who  pretended  to  fire 
the  cannon  to  amuse  themselves,  but  whose  real  object  was  to 
make  a  pretext  for  causing  him  to  die  of  hunger  by  reducing 
more  and  more  the  allowance  of  food.  A  still  more  remarkable 
case  was  that  of  a  captain  of  the  Imperial  Guard,  who  had  been 
admitted  into  Charenton  a  few  weeks  only  before  the  outbreak 
of  the  war,  labouring  under  delusions  of  persecution.  From  his 
profession,  from  the  fact  that  he  had  several  relatives  in  the 
army,  from  his  perfect  lucidity  on  many  subjects,  it  might  have 
been  expected  that  he  would  follow  the  events  of  the  war  with 
interest.  ISTothing  of  the  kind :  all  the  defeats  and  sieges,  the 
fall  of  the  empire,  the  investment  of  Paris,  the  conflicts  before 
it,  various  episodes  of  which  he  saw,  the  bombardment  of  the 


424  PATHOLOGY  OF  MIND.  [chap. 

forts  wiiicli  he  heard  incessantly,  the  capitulation  of  Paris  and 
its  deplorable  consequences — all  were  met  with  entire  incre- 
dulity. He  would  not  believe  a  word  of  what  he  w^as  told, 
although  every  means  was  employed  to  convince  him,  but  de- 
clared that  all  the  noise  made  by  the  cannonading  was  the 
work  of  certain  officers  of  his  regiment — his  persecutors — who 
were  bent  upon  annoying  him,  and  that  the  authorities  of  the 
asylum  made  common  cause  with  them  by  refusing  to  forward 
his  letters  to  his  relatives,  and  by  withholding  from  him  their 
replies.  He  was  one  day  shown  five  or  six  newspapers,  all  of 
the  same  date  and  relating  the  same  facts;  he  read  them  with 
incredulity,  alleging  that  they  were  sham  newspapers,  printed 
for  him  alone  by  his  persecutors,  who  were  determined  not  to 
desist  from  their  persecution,  cost  them  what  it  might.  When 
a  person  has  got  so  completely  out  of  sane  relations  with  his 
surroundings  as  to  cherish  the  sort  of  extravagant  delusion 
which  the  monomaniac  has  the  plainest  evidence  affects  him 
not  in  the  least  if  it  goes  against  his  opinion;  his  judgment 
upon  all  matters  that  concern  himself  is  utterly  disorganised 
and  rotten :  it  is  engulfed  in  the  morbid  self. 

o 

The  insane  person  who  believes  himself  to  be  Jesus  Christ  is 
commonly,  while  in  the  asylum,  well-behaved,  courteous,  digni- 
fied in  manner,  evincing  in  bearing,  gait,  and  speech  a  placid 
exaltation  and  serene  self-confidence ;  but  he  is  very  likely  to 
be  dangerous  if  he  be  left  at  large.  By  a  pathological  logic  he 
develops  some  other  great  delusive  notion — that  he  must  dis- 
cover or  attest  his  divinity,  or  draw  an  unbelieving  generation's 
attention  to  it  by  some  mighty  deed ;  accordingly  he  may  sacri- 
fice his  own  life  or  the  lives  of  others  in  order  to  give  proof 
of  his  divine  mission,  or  perhaps  to  redeem  mankind  by  the 
baptism  of  blood ;  or  he  may  do  some  other  desperate  deed 
from  an  equally  insane  motive.  At  all  times  he  is  possessed 
with  a  thoroughly  insane  exaltation,  and  there  can  be  no  certi- 
tude felt  that  it  may  not  explode  in  equally  insane  conduct. 

The  foregoing  considerations  render  it  easy  to  understand 
that  a  fixed  monomania  which  ends  not  in  recovery  will  pro- 
bably entail  eventually  an  increasing  impairment  of  mind ; 
like  a  cancer  or  other  morbid  growth  that  has  fixed  itself  in 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  425 

some  tissue  of  the  body,  it  is  nourished  at  tb.e  cost  and  to  the 
detriment  of  the  sound  elements,  which  dwindle  and  degenerate, 
and  the  result  is  a  state  of  mental  disorganisation  and  decay, 
which  may  be  justly  described  either  as  chronic  mania  or 
dementia,  according  as  the  degree  of  degeneration  is  less  or 
greater. 

Dementia, 

Most  of  the  permanent  inmates  of  asylums  are  persons  who 
after  a  more  or  less  acute  mental  derangement  have  sunk  into  a 
condition  of  permanent  mental  feebleness  and  incoherence.  To 
describe  in  detail  the  different  varieties  of  degeneracy  which  are 
met  with  Avould  be  an  endless  and  barren  labour.  It  would  be 
as  tedious  as  to  attempt  to  describe  particularly  the  exact  cha- 
racter of  the  ruins  of  each  house  in  a  city  that  had  been 
destroyed  by  an  earthquake :  in  one  place  a  great  part  of  the 
house  may  be  left  standing,  in  another  place  a  wall  or  two,  and 
in  a  third  the  ruin  is  so  great  that  hardly  one  stone  is  left  upon 
another.  So  with  respect  to  the  mental  WTecks  that  are  seen  in 
long-standing  insanity :  one  person  will  talk  reasonably  and 
calmly  for  a  while  on  most  subjects,  until,  his  enfeebled  attention 
being  exhausted  or  the  trains  of  his  many  morbid  ideas  hit  upon, 
he  breaks  off  into  rambling  and  incoherent  nonsense ;  the  con- 
versation of  another  is  habitually  incoherent,  although  he  may 
for  a  short  time  or  on  some  occasions  so  far  hold  his  attention 
as  to  answer  rationally  simple  questions  put  directly  to  him;  a 
third  is  utterly  crazy  and  scarcely  ever  utters  a  word  of  sense. 
Between  what  is  described  as  chronic  mania  and  what  is  known 
as  dementia  it  is  evident  then  that  the  distinction  must  be 
theoretical. 

Three  principal  groups  may  be  made  of  these  cases  of  mental 
disorganisation.  The  first  will  consist  of  those  who,  representing 
the  terminal  dementia  of  monomania,  still  exhibit  a  few  strikinsj 
delusions,  which  now,  however,  seem  to  be  automatically  ex- 
pressed ;  for  the  strong  self-feeling  which  formerly  underlay  and 
inspired  them  is  extinct,  and  there  is  none  of  the  earnestness,  con- 
sistency, and  self-assertion  which  there  was  once.     They  quietly 


426  PATHOLOGY  OF  MIND.  [chap. 

give  utterance  to  the  most  extravagant  delusions  as  if  they  were 
saying  the  most  trivial  commonplaces,  and  seldom  show  any 
feeling  when  they  are  contradicted.  The  paths  of  mental  asso- 
ciation are  obstructed  or  broken  up,  so  that  the  delusions  are  cut 
off  from  any  systematic  and  active  influence  upon  such  mental 
functions  as  are  left,  and  the  incoherence  is  extreme.  Family 
and  social  feelings  are  pretty  nigh  extinct;  they  ask  not  and 
care  not  for  relations,  and  all  real  interest  in  the  past  and  present 
is  abolished.  How  can  there  be  a  past  when  its  organic  regis- 
trations are  disorganised ;  how  can  there  be  a  present  when  there 
are  no  linked  memories  of  the  past  to  give  it  meaning  and  in- 
terest ?  Their  acts  exhibit  a  corresponding  imbecility.  Several  of 
them  are  capable  of  employing  themselves  in  useful  mechanical 
labour  under  suitable  supervision ;  but  the  industry  of  others  is 
confined  to  strange  antics  and  monotonous  gestures,  to  walking 
backwards  and  forwards  for  a  certain  distance  over  a  particular 
path,  to  crouching  or  standing  in  a  particular  corner,  or  to  gather- 
ing stones,  pieces  of  paper,  and  the  like.  Some  of  the  movements 
witnessed  which  are  definite  and  uniformly  repeated,  albeit 
strange  in  character,  are  probably  dictated  by  the  remains  of  an 
extraordinary  delusion  or  hallucination :  one  person,  for  example 
who  day  after  day  licks  with  his  tongue  a  certain  place  on  the 
wall  or  on  some  other  object  imagines  that  he  is  tasting  some- 
thing of  delicious  savour ;  another,  the  singular  movements  of 
whose  arms  perplex  the  observer,  is  busy  spinning  sunbeams 
into  threads  ;  a  third  is  constantly  shouting  in  answer  to  voices 
which  he  alone  hears  ;  a  fourth  keeps  up  violent  movements  of 
his  arms  in  order  to  prevent  his  blood  from  coming  to  a  stand- 
still. Other  strange  movements  which  we  cannot  account  for 
might  probably  have  been  similarly  explained  had  we  been  able  to 
watch  carefully  the  evolution  of  the  insanity  and  to  follow  closely 
the  steps  of  the  mental  dissolution  that  has  taken  place.  For 
the  explanation  of  others  it  might  be  necessary  to  search  even 
yet  further  back —  to  make  the  reversion  to  ancestral  experiences 
which  they  perhaps  represent.  The  bodily  health  is  usually 
good,  there  being  not  unfrequently  an  improvement  in  this 
respect  as  the  frenzy  of  mania  or  of  melancholia  subsides  into 
tlie  peace  of  dementia.     The  mood  of  mind,  which  appears  to  be 


viii.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  427 

determined  in  great  measure  by  the  patient's  former  disposition, 
may  be  surly  and  gloomy,  or  brisk  and  cheerful,  or  even  and 
placid. 

In  a  second  group  of  cases  there  is  more  general  incoherence — 
a  genuine  craziness  in  fact — without  the  expression  of  particular 
delusions,  but  with  a  gi^eater  display  of  outward  activity.  Their 
incoherent  drivel  or  their  senseless  parrot-like  repetitions  of 
certain  words  may  discover  the  wrecks  of  delusions  which  existed 
in  the  preceding  maniacal  stage.  The  fact  is  that  the  mental 
disorganisation  has  gone  so  far  that  not  only  are  the  paths  of 
association  broken  up,  but  the  centres  themselves  of  ideas  also ; 
there  is  an  incapacity  to  receive  accurately  and  to  fashion  into 
ideas  the  impressions  made  upon  the  senses,  as  well  as  a  great 
loss  of  memory ;  and  in  extreme  cases  the  capability  of  a  dis- 
tinct delusion  and  of  a  definite  passion  is  gone.  An  entire  in- 
difference to  what  is  going  on  around,  reaching  a  placidity  beyond 
^^'hat  philosophy  can  attain  unto,  would  certainly  warrant  it 
being  said  of  him  more  truly  than  of  the  just  and  self-contained 
man — 

"  Si  fractus  illabatur  orbis 
Impavidum  ferient  ruinsB.'' 

The  extinction  of  all  emotional  feeling  of  the  higher  sort  is 
frequently  accompanied  by  a  bluntness  of  sensation,  in  conse- 
quence of  which  the  patient  shows  himself  singularly  insensible 
to  pain,  being  very  little  affected  by  so  severe  an  injury  as  a 
broken  arm  or  a  broken  leg.  Sometimes  the  sensations  are 
manifestly  vitiated,  as  shown  by  tendencies  to  swallow  stones, 
live  frogs,  worms,  and  the  like;  these  perverted  appetites  coming 
on  or  being  more  marked  perhaps  at  certain  times  and  then  dis- 
appearing or  abating  for  a  while.  In  some  cases  paroxysms  of 
excitement  occur  from  time  to  time,  and  there  are  outbursts  of 
incoherent  passion  and  fury  or  even  of  desperate  homicidal 
violence  without  any  apparent  cause  in  external  circumstances 
to  provoke  them.  A  demented  person  under  my  care  who  was 
utterly  incoherent,  used  to  walk  about  muttering  te  himself, 
without  any  one  ever  being  able  to  understand  what  he  mut- 
tered or  to  get  an  intelligent  answer  from  him  ;  from  time  to 
time,  without  giving  the  least  warning,  and  without  anything 


428  PATHOLOGY  OF  MIND.  [chap. 

having  happened  to  provoke  his  anger,  he  would  rush  upon  some 
one  and  strike  him  violently  or  make  a  furious  attempt  to  strangle 
him  ;  so  sudden  and  dangerous  were  these  outbreaks  that  nothing 
would  induce  an  attendant  who  knew  his  propensities  to  sleep  in 
the  same  room  with  him.  Another  instance  :  a  heavy,  wild-look- 
ing, hopelessly  demented  woman,  who  usually  did  no  more  than 
laugh  vacantly  when  spoken  to,  and  seemed  not  to  comprehend 
what  was  said,  used  to  begin  every  now  and  then,  without  ap- 
parent reason,  to  shriek  and  howl  furiously,  and  to  stamp  on  the 
ground  violently,  her  whole  body  being  agitated  convulsively ; 
the  paroxysm  would  end  either  in  a  violent  attack  upon  some 
one,  made  with  the  rush  of  an  avalanche,  or  she  would  throw 
herself  down  on  the  ground  and  lie  there  shrieking  and  kicking 
for  some  minutes  ;  after  which  she  would,  with  maniacal  drawl, 
murmur,  "  I  beg  pardon,"  "  I'm  very  sorry." 

Some  of  the  homicides  that  are  done  in  asylums  are  done  by 
demented  patients  of  this  class :  one  who  has  worked  side  by 
side  with  another  for  months  without  ever  having  shown  the 
least  ill-will  suddenly  smashes  his  skull  one  day  with  a  spade 
or  a  hammer;  and  it  will  most  likely  be  impossible  to  get  fi^om 
him  any  explanation  of  the  murderous  deed.  The  probable 
explanation  is  that  some  bodily  derangement  has  occasioned  a 
painfully  uneasy  disturbance  of  the  affective  tone,  and  that  a 
straggling  idea  of  a  suspicious  nature  arising  into  activity  in 
this  atmosphere  or  medium  of  gloomy  feeling,  and  unrestrained 
by.  other  ideas  from  which  it  is  cut  off  by  the  disorganisation  of 
the.  paths  of  association,  acquires  a  delusive  character  and  a 
convulsive  energy.  The  tendency  of  the  gloomy  mood  is  to 
outward  expression,  and  the  upstarting  idea  has  determined  the 
direction  of  its  discharge  and  discharged  it  in  the  deed  of 
violence. 

The  prevailing  mood  of  these  dements  is  different  in  different 
cases  :  some  are  gay,  happy,  and  chatter  and  laugh  incessantly  ; 
others  are  gloomy  and  display  the  mimicry  of  grief ;  while 
others,  again,  are  malicious,  spiteful,  destructive,  and  addicted 
to  a  purposeless  mischief  with  a  monkey-like  cunning  and  per- 
sistence. The  bodily  health  is  usually  good  and  the  bodily 
functions  are  well  performed ;  some  of  them  get  fat,  and  remain 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  429 

so  until  an  witbreak  of  excitement  and  agitation,  to  wliicli 
they  are  liable  periodically,  reduces  them.  The  physiognomy  is 
blank  and  expressionless,  especially  when  the  patient  is  spoken 
to,  or  it  expresses  only  in  coarse  traits  the  predominant  mood ; 
it  is  often  also  prematurely  aged. 

Lastly,  there  is  a  group  of  demented  patients  in  whom  nearly 
"all  traces  of  mind  are  extinguished :  they  must  be  fed,  moved, 
clothed,  and  cared  for  in  every  way;  they  evince  little  or  no 
sensibility ;  their  only  utterance  is  a  grunt,  a  moan,  a  wdiine,  or 
a  cry ;  and  the  only  movements  wdiich  they  make  of  their  own 
accord  are  to  rub  their  heads,  their  hands,  or  other  parts  of  their 
bodies,  or  to  continue  some  other  meaningless  and  monotonous 
movements.  They  represent  the  lowest  of  the  degrees  of  de- 
mentia— the  last  term  of  mental  dcOTadation  to  w^hich  it  is 
possible  for  a  human  being  to  sink.  Their  life  is  in  truth  little 
more  than  a  vegetative  existence ;  mental  dissolution  has  anti- 
cipated bodily  dissolution ;  and  if  they  are  not  carried  off  by 
pneumonia,  tubercle,  or  some  other  w^elcome  bodily  disease,  as 
they  sometimes  are,  they  die  from  effusion  on  the  brain,  serous 
or  hsemorrhagic,  or  from  atrophy  thereof,  or  from  the  effects  of 
accident  to  wdiich,  in  consequence  of  their  apathetic  helpless- 
ness, they  are  much  exposed.  It  is  a  robust  faith  which  infixes 
the  certitude  of  a  resurrection  to  life  eternal  of  this  mind  which 
is  seen  to  dawn  with  the  opening  functions  of  the  senses,  to 
grow  gradually  as  the  body  grows,  to  become  mature  as  it 
reaches  maturity,  to  be  warped  as  it  is  warped  by  faulty  inhe- 
ritance, to  be  sick  with  its  sicknesses,  to  decay  as  it  decays, 
and  to  expire  as  it  expires. 

Before  leaving  this  subject  it  will  be  proper  to  take  notice 
that  dementia  is  not  alw^ays  chronic,  secondary,  and  incurable, 
but  sometimes  acute,  primary,  and  curable.  Acute  dc^ncntia, 
[when  it  occurs,  is  usually  the  effect  of  sojne  severe  mental  or 
bodily  shock.  It  has  followed  the  shock  of  a  serious  attempt  at 
strangulation.  One  observes  it  in  greater  or  less  degree  after 
an  epileptic  fit  or  a  succession  of  such  fits,  occasionally  in  an 
extreme  form ;  for  example,  in  one  case  that  came  under  my 
notice — that  of  a  delicately  constituted  person  who  was  said  to 
have  had  "  fits  "  from  time  to  time— what  was  called  a  slight 


430  PATHOLOGY  OF  I\IIND.  [chap. 

"faintness,"   but   was  probably  an  epileptic  vertigo,  was   fol- 
lowed by  a  blank  confusion  of  mind,  an  entire  incoherence,  and 
a  complete  inability  to  recognise  anybody  or  anything — a  con- 
dition, in  fact,  of  extreme  dementia,  which  lasted  for  a  few  days. 
After  a  severe  attack  of  acute  mania,  as  after  the  delirium  of 
fever  in  some  instances,  a  condition  of  mental  confusion  and 
feebleness  may  be  left,  which  is  truly  a  temporary  dementia 
and    is   gradually  recovered  from.     Again,    acute  dementia  is 
sometimes  caused  by  a  moral  shock.     A  pale,  delicate,  fragile, 
blue-eyed  young  lady  once  came  under  my  care  after  she  had 
been  ill  for  a  week.     She  had  scarcely  taken  any  food,  and  was 
much  exhausted.     Her  vacant,  wandering  eyes  were  devoid  of 
all  intelligent  perception,  and  her  countenance  was  blank  and 
expressionless.     There  was  a  restless,   agitating  movement  to 
and  fro  of  the  body  generally,  and  of  the  head  in  particular, 
with  a  low  monotonous  moaning.     She  was  speechless,  and  it 
was  impossible  to  fix  her  attention  or  to  elicit  any  kind  of  intel- 
ligent response.     She  took  no  food  except  what  was  forced  into 
her  mouth,  and  was  inattentive  to  the  calls  of  nature.     "Within 
three  months  she  recovered  under  suitable  treatment.     She  had 
suffered  a  great  disappointment  of  her  affections ;  menstruation 
had   ceased  ;   and  acute   dementia  had  followed.     In  another 
case,  a  young  gentleman,  nineteen  years  of  age,  of  pale  and 
delicate  appearance,  with  large  prominent  grey  eyes,  who  had 
been  hard  worked  as  clerk  in  an  office,  and  whose  life  out  of  it 
had  not  been  satisfactory  to  his  friends,  was  suddenly  attacked 
with  a  quasi-hysterical  attack  of  incoherence.     There  was  blank 
confusion  of  mind ;  he  neither  uttered  nor  otherwise  expressed 
anything  indicating  intelligence  in  his  mind,   and  showed  no 
sign  of  understanding  what  was  said  to  him  by  others ;  and 
there  were  occasional  periods  of  confused  excitement.     He  took 
no  food  except  what  was  forced  upon  him,  and  he  was  inatten- 
tive  to   the   calls   of   nature.     Eecovery  took  place  within  a 
month. 

The  late  Dr.  Skae  described,  under  the  name  of  sexual  insanity, 
a  form  of  acute  dementia  met  with  according  to  him  both  in  the 
male  and  female  sex,  but  more  often  in  the  latter,  which  he  be- 
lieved to  be  produced  by  the  moral  and  physical  effects  of  sexual 


VIII.]  THE  SYMPTOMATOLOGY  OF  INSANITY.  431 

intercourse  upon  the  nervous  system.  There  is  some  reason  to 
think  that  habits  of  excessive  self-abuse  have  been  the  cause 
of  a  similar  form  of  derangement  soTnetimes  in  persons  of  feeble 
constitution  and  highly  nervous  temperament. 

The  examples  which  I  have  given  will  serve  to  exhibit  the 
general  features  of  acute  dementia,  and  to  indicate  the  favourable 
character  of  the  prognosis.  The  mental  functions  are  abolished 
for  the  time  by  reason  of  some  severe  shock  to  their  nerve- 
centres,  and  the  abeyance  of  them  is  shown  by  the  expression- 
less countenance  of  the  patient,  his  passive  attitude  of  body  or 
meaningless  movements,  perhaps  by  an  occasional  aimless  and 
confused  excitement,  by  his  inability  to  understand  what  is  said 
or  to  say  what  can  be  understood,  and  by  loss  of  general  sensi- 
bility. If  recovery  does  not  take  place  soon,  as  in  most  cases 
it  does,  there  is  danger  lest  the  disease  pass  into  chronic  and 
incurable  dementia. 


NOTE. 

In  mentioning,  at  p.  319,  the  species  of  insanity  which  has  been 
described  as  agoraphobia,  reference  should  have  been  made  to  three 
cases  described  in  the  Archiv  f.  Psychiatrie  u.  Nerv&nhrankheiten, 
Band  VII.,  2  Heft,  and  to  the  Annales  Medico-Psychologique,  No- 
vember, 1876,  p.  405.  One  of  the  patients  says  of  himself  : — "  From 
my  early  youth — in  my  sixteenth  year — I  could  scarcely  cross  a 
large  open  space  alone,  or  even  a  large  open  space  in  a  church  or  in 
a  concert-room,  without  suffering  from  an  overwhelming  feeling  of 
distress."  To  cross  a  square  alone  he  must  go  round  the  houses.  If 
he  had  a  companion  and  was  engaged  in  conversation  he  had  no 
difficulty.  If  he  attempted  it  aloue,  he  must  fix  his  eye  upon  a 
cart,  carriage,  or  person  in  the  middle  of  the  square  as  a  point  to 
be  aimed  at,  and  so  get  across  from  one  object  to  another.  In  vain 
he  had  tried  to  overcome  his  fears.  It  was  not  actual  giddiness,  but 
an  indescribable  distress  that  affected  him.  I  have  recently  seen  a 
similar  case  of  a  nervous  gentleman  who  cannot  cross  a  square,  but 
must  go  round  by  the  houses,  unless  he  is  accompanied. 


CHAPTER  IX. 

CLINICAL   GROUPS   OF  MENTAL   DISEASE. 

When  we  have  to  do  with  insanity  in  medical  practice — that  is 
to  say,  when  we  have  to  think  how  a  particular  case  has  been 
caused,  what  course  it  will  run,  how  it  will  end,  and  what  sort  of 
treatment  should  be  used,  we  do  not  so  much  consider  whether 
the  symptoms  are  mania  or  melancholia  as  we  do  what  consti- 
tutional diathesis  underlies,  or  what  bodily  disturbance  accom- 
panies, the  derangement.  It  is  certain  that  we  get  more  help 
generally  from  the  exact  observation  and  appreciation  of  such 
bodily  states  than  we  do  from  the  mental  symptoms  alone :  for 
example,  whether  a  mental  disorder  is  maniacal  or  melancholic 
is  not  of  much  moment,  but  the  recognition  of  a  gouty  dispo- 
sition, of  a  syphilitic  infection,  of  a  commencing  paralysis,  of  a 
puerperal  cause,  and  the  like,  will  help  us  much.  It  is  proper, 
therefore,  to  enumerate  and  describe  the  principal  clinical  varie- 
ties of  mental  disorder.  To  the  late  Dr.  Skae  belongs  the  merit 
of  having  insisted  strongly  upon  this  clinical  classification  of 
mental  diseases,  and  of  having  been  the  first  to  sketch,  although 
vaguely,  the  leading  features  of  numerous  groups. 

General  Paralysis  of  the  Insane. 

For  many  years  now — since  Bayle  first  distinguished  them — 
a  group  of  cases  presenting  characteristic  features  have  been 
described  under  this  head,  and  they  unquestionably  constitute 
the  most  definite  and  satisfactory  example   of  a  clinical  variety 


CI.  iX.]         CLINICAL  GROUPS  OF  MENTAL  DISEASE.  433 

of  mental  disease.  For  tliat  reason  I  begin  with  them.  They 
represent  a  form  of  disease  which  is  characterised  by  a  progi^es- 
sive  diminution  of  mental  power,  and  by  a  paralysis  which 
creeps  on  stealthily,  increases  gradually,  and  invades  progres- 
sively the  whole  muscular  system.  The  concurrence  and  con- 
current increase  of  mental  and  motor  disorder  are  not  accidental 
but  constant :  the  patient  loses  the  power  of  performing  both 
ideas  and  movements,  and  gets  worse  and  worse  gradually  in 
both  respects  until  he  dies.  In  the  great  majority  of  cases 
there  are  extremely  exalted  delusions  of  personal  power,  or 
wealth,  or  grandeur ;  but  as  they  are  not  present  always,  it  is 
impossible  to  make  the  character  of  the  delusion  a  necessary 
part  of  the  definition  of  the  disease.  Indeed,  all  the  varieties  of 
mental  symptoms — melancholia,  mania,  monomania,  dementia — 
may  be  met  with  in  different  cases  of  general  paralysis  ;  but  what 
will  be  observed  always  is,  that  whether  the  symptoms  are 
melancholic  or  maniacal,  there  is  a  marked  weakness  of  the 
understanding  and  memory  which  there  is  not  in  ordinary  cases 
of  melancholia  and  mania. 

General  paralysis  gets  a  painful  interest  from  the  fact  that  it 
attacks  those  who  seem  to  be  in  the  prime  of  life  and  at  the  full 
height  of  their  energy,  and  that  it  selects  so  many  of  its  victims 
in  the  better  classes  of  society.  Ilereditaiy  predisposition  is 
less  often  met  with  than  in  other  forms  of  mental  disease ;  and 
there  is  no  little  uncertainty  as  to  what  is  the  most  frequent 
exciting  cause.  Sexual  excesses  I  hold  confidently  to  have  that 
evil  pre-eminence,  but  I  doubt  not  that  a  certain  temperament, 
oftentimes  of  a  genial  and  expansive  kind,  must  co-operate. 
Those  who  reject  this  opinion  object  that  the  sexual  excitement 
observed  is  really  an  effect  of  the  malady,  and  that  it  counts 
among  its  victims  more  respectable  married  persons  than  un- 
married persons  of  incontinent  lives.  ISTeither  objection  has 
the  weight  which  at  first  sight  it  appears  to  have.  Iso  doubt 
there  is  oftentimes  increased  sexual  excitement  at  the  be^inninGj 
of  the  disease — I  overlook  not  that — but  there  is  not  even  then 
corresponding  sexual  power,  and  very  soon  the  excitement 
vanishes  in  complete  impotence.  It  is  not  to  this  temporary 
excitement  that  I  refer,  but  to  the  steady  sexual  excesses  which 


434  PATHOLOGY  OF  MIKD.  [chap. 

have  gone  before  the  first  symptoms  of  illness  and  have  by 
degrees  sapped  the  vitality  of  the  nervous  system.  He  can 
have  but  little  experience  and  little  insight  as  a  physician  who 
does  not  know  that  this  sort  of  steady  sapping  excess  is  as 
common  or  even  more  common  among  married  persons,  with 
whom  provocation  and  opportunity  are  constantly  at  hand, 
than  among  unmarried  persons  who  have  often  to  seek  or  to 
make  the  occasions  of  indulgence.  ISlot  a  few  married  persons, 
moreover,  are  so  innocent  as  to  believe  that  there  cannot  be  such 
a  thing  as  sexual  excess  when  the  Church  has  consecrated  the 
union,  and  they  yield  to  habitual  indulgence  which  is  gross  ex- 
cess, without  thought  of  harm  to  themselves.  General  paralysis 
is  emphatically  a  disease  of  manhood,  being  seldom  met  with 
before  thirty  or  after  sixty  years  of  age.  In  two  cases  I  have 
known  it  to  occur  after  sixty :  one  gentleman  had  married  late 
in  life,  after  he  had  made  a  large  fortune  in  active  business,  a 
woman  much  younger  than  himself  who  was  evidently  of  large 
receptive  capacity ;  the  other,  w^ho  had  made  his  fortune  by 
persevering  industry  and  an  almost  miserly  carefulness,  had 
betaken  himself  in  the  evening  of  his  life  to  politics  and  to 
keeping  a  mistress. 

It  is  a  noteworthy  fact  that  women  very  seldom  suffer,  and 
women  of  the  better  classes  hardly  ever,  from  general  paralysis : 
perhaps  it  is  that  women  are  not  subjected  to  such  severe  and 
constant  mental  strain  as  men  are ;  that  they  are  not  so  much 
addicted  to  alcoholic  intemperance,  either  in  the  shape  of  acute 
excesses  or  in  that  more  dangerous  form  of  habitual  indulgences 
in  small  quantities  of  win-e  and  spirits  throughout  the  day  by 
which  some  active  men  of  business  endeavour  to  spur  their 
overtasked  energies ;  or,  lastly,  that  they  are  not  so  prone  to, 
and  suffer  not  so  much  from,  sexual  excesses  as  men  do.  Another 
noteworthy  fact  is  that  the  disease  is  very  rare  in  some  parts  of 
the  country ;  for  example,  it  is  said  to  be  very  uncommon  in 
many  parts  of  Ireland,  and  hardly  ever  to  be  met  with  in  the 
Highlands  of  Scotland,  where  of  course  there  is  no  deficiency 
either  of  women  or  of  whisky.  I  doubt,  however,  whether 
persons  who  spend  most  of  the  day  in  the  open  air,  going 
through  a  great  deal  of  bodily  exercise,  are  so  easily  provoked 


IX.]  CLINICAL  GROUPS  OF  MENTAL  DISEASE.  435 

to  indulgence  or  so  inclined  to  excesses,  sexual  or  alcoholic,  or 
again  suffer  so  easily  from  theni,  as  the  dwellers  in  town,  who 
have  another  source  of  drain  of  energy  in  their  habitual  greater 
mental  strain  and  anxiety.  Some  writers  deem  syphilis,  others 
intemperance,  to  be  the  most  frequent  cause  of  the  disease. 

It  has  been  disputed  whether  the  mental  symptoms  precede 
the  paralytic  symptoms,  or  whether  the  latter  occur  first — 
whether,  in  fact,  the  insanity  is  essentially  primary,  or  whether 
the  paralysis  is  the  primary  and  main  affection,  the  mental 
disorder  being  secondary.  A  barren  controversy:  observation 
certainly  shows  that  the  mental  symptoms  are  evinced  in  many 
cases  before  there  is  a  trace  of  paralysis,  and  that  in  other 
cases  the  mental  and  motor  symptoms  appear  simultaneously. 
Instances  again  do  occur  occasionally  in  which  the  paralytic 
phenomena  appear  first ;  and  some  have  been  recorded  in 
which  the  disease  undoubtedly  began  in  the  spinal  cord  and 
spread  thence  to  the  brain.  In  cases  which  begin  so  it  will  be 
noticed  sometimes  that  the  walk  is  that  which  is  characteristic 
of  so-called  tales  dorsalis — uncertain,  swaying,  the  feet  being 
raised  and  thrown  forward  abruptly  or  outwards  to  the  right 
and  left,  and  brought  dow^n  with  a  jerk  on  the  ground.  It  is 
certain,  in  fact,  that  some  cases  begin  as  tahes  dorsalis  and  end 
as  general  paralysis ;  but  this  sequence  is  not  usual,  for  the  mind 
is  commonly  cheerful  and  unaffected  unto  the  end  in  the  former 
disease.  I  take  it  to  be  certain  also  that  in  a  few  cases  of 
general  paralysis  the  motor  symptoms,  which  were  not  those 
of  tahes  dorsalis  in  the  first  instance,  became  the  motor 
symptoms  of  that  disease  later  on.  Dr.  Skae  was  of  opinion 
that  the  paralysis  was  the  essential  part  of  the  disease,  and  that 
it  might  go  on  to  a  fatal  ending  sometimes  with  only  a  slight 
impairment  of  the  mental  functions,  or  without  any  affection  of 
them  at  all  ;  and  in  support  of  this  view  he  related  the  case  of 
a  gentleman  who  laboured  under  the  peculiar  paralysis  of  the 
disease  for  many  years,  during  all  which  time  he  was  esteemed 
a  man  of  great  intelligence.  Ultimately  he  was  attacked  with 
the  extreme  delusions  of  grandeur,  and  died  with  all  the  signs 
of  general  paralysis  running  its  usual  course.  Before  asserting 
that  there  is  no  trace  of  paralysis,  or  no  trace  of  mental  dis- 


436  PATHOLOGY  OF  I\I1ND.  [chap. 

order  in  a  particular  case,  it  will  be  well  to  observe  tlie  patient 
when  he  is  emotionally  excited  or  after  a  sleepless  night ;  for  as 
both  motor  and  mental  symptoms  may  come  and  go  at  the 
beginning  of  the  malady,  there  may  then  be  evidence  of  tremu- 
lousness  and  uncertainty  about  the  muscles  of  speech  or  signs 
of  mental  impairment  which  would  not  be  observed  when  he  is 
calm  and  collected. 

The  motor  symptoms  are  noticed  first  in  the  tongue  and  lips, 
which  have  to  execute  so  many  delicate  and  complex  move- 
ments wdth  exact  precision,  and  especially  in  the  articulation  of 
words  abounding  in  consonants,  where  the  most  complex  co- 
ordination of  movements  is  necessary ;  w^hen  the  patient  speaks 
earnestly,  he  does  not  articulate  clearly,  and  there  is  a  certain 
pause  or  thickness  or  stumbling  in  his  utterance,  as  if  there  was 
a  difficulty  in  bringing  out  the  syllables  ;  in  some  cases  the 
speech  is  slower,  more  deliberate,  with  a  strong  accentuation  of 
and  a  lingering  on  the  syllables,  as  if  he  w^ere  speaking  with  great 
consideration.  When  the  tongue  is  put  out,  which  it  is  with 
some  difficulty,  there  may  be  a  fibrillar  quivering  of  its  muscles, 
or  a  trembling  of  the  whole  of  it,  but  it  is  not  pulled  to  one  side. 
There  is  a  tremulousness  also  in  the  muscles  of  expression  when 
they  are  put  in  action,  especially  in  those  of  the  lips,  which 
quiver  as  in  one  just  about  to  burst  into  tears.  The  tone  of 
the  voice  is  often  altered,  although  this  may  be  noticeable  only 
by  those  wdio  have  known  the  patient  well  before  he  was  taken 
ill ;  it  becomes  harsher  and  loses  its  various  shades  of  expression. 
These  symptoms  are  more  evident  when  there  is  any  mental  ex- 
citement. An  inequality  in  the  size  of  the  pupils  is  often  an 
early  symptom,  but  it  is  not  a  characteristic  one ;  it  is  some- 
times present  in  other  forms  of  insanity,  and  it  is  not  always 
present  in  general  paralysis.  In  a  few  cases  the  pupils  are  con- 
tracted to  a  pin's  point.  A  transitory  squint  is  observed  occa- 
sionally at  the  commencement  of  the  disease,  and  at  a  later 
period  perhaps  a  slight  ptosis  of  the  upper  eyelid. 

As  the  disease  advances  the  muscles  of  the  limbs  and  trunk 
are  affected;  in  walking,  the  feet  are  not  quietly  raised  and 
firmly  planted  on  the  ground,  and  the  gait  is  somewhat  feeble 
and  shuffling ;  the  patient  will  find  some  difficulty  in  mounting 


IX.]  CLINICAL  GROUPS  OF  MENTAL  DISEASE.  437 

on  to  a  cliair,  easily  stumbles  at  a  step  or  on  uneven  ground, 
and,  if  asked  suddenly  to  turn  round  when  going  straight  for- 
ward, he  sometimes  sways  or  staggers  like  a  drunken  man. 
Nevertheless  he  may  be  energetic  in  walking,  setting  about  it 
earnestly,  as  if  it  were  his  business,  and  pleased  with  his  per- 
formance of  it ;  he  does  not  want  muscular  power,  but  the  power 
of  using  his  muscles ;  he  is  unaware  of  his  deficiencies  and  com- 
monly thinks  himself  wonderfully  well  and  strong.  Precise  co- 
ordination of  movement,  such  as  is  necessary  for  writing,  sewing, 
playing  upon  a  musical  instrument,  and  like  acquired  automatic 
acts,  is  much  impaired  or  quite  lost.  At  the  outset  of  the 
disease  it  is  sometimes  very  difficult  for  one  unacquainted  with 
the  patient  before  his  illness  to  perceive  anything  peculiar  in  his 
walk;  but  when  no  symptoms  of  paralysis  are  detected,  there 
may  be  something  stiff,  proud,  abrupt  about  it ;  the  steps  shorter 
and  quicker,  and  the  foot  being  set  down  more  sharply.  One  set 
of  muscles  may  be  more  affected  in  one  case,  and  another  set  in 
another ;  and  it  is  noticed  sometimes  that  the  articulation  is  most 
impaired  when  the  legs  and  arms  are  scarcely  touched,  or  again 
that  there  is  no  impairment  of  articulation  when  there  is  marked 
paralysis  of  the  legs.  Like  the  mental  symptoms,  the  motor  symp- 
toms may  disappear  almost  entirely  for.  a  time.  As  the  disease 
advances  towards  its  end,  the  articulation  becomes  less  distinct ; 
the  w^alk  more  and  more  tottering ;  the  knees  fail ;  the  patient 
frequently  tumbles,  and  finally  is  unable  to  get  up  at  all.  The 
contractility  of  muscles  for  the  electric  stimulus  is  retained.  At 
last  the  primary  automatic  or  reflex  movements  fail ;  the  pupils 
become  dilated,  but  unequal  in  size ;  the  sphincters  lose  their 
power;  and  the  patient,  who  is  very  apt  to  swallow  his  food 
without  masticating  it  properly,  may  be  choked  by  a  lump  of  it 
sticking  in  the  paralysed  pharynx  and  blocking  up  the  opening 
of  the  larynx  or  even  getting  into  the  larynx.  Transitory  con- 
tractions of  an  arm  or  leg  occur  sometimes,  and  a  persistent 
grinding  of  the  teeth  is  not  uncommon  in  the  last  stages  of  the 
disease. 

Cutaneous  sensibility  is  diminished  in  the  earl}'  stages,  and 
towards  the  end  it  is  sometimes  almost  lost.  These  patients 
when  injured  by  violence  make  no  complaint  perhaps,  and  go 


438  PATHOLOGY  OF  MIND.  [chap. 

about  even  with  broken  ribs  without  showing  any  sign  of  pain. 
A  sudden  local  perversion  or  loss  of  sensation  may  be  the  occa- 
sion of  an  extravagant  delusion — e.g.  that  one  half  the  face  or 
chest  has  been  torn  away.  In  some  cases  transitory  attacks 
of  extreme  hypera^sthesia  of  parts  cause  the  patient  to  shriek 
out  in  agony ;  and  before  the  disease  shows  itself  it  is  not  very 
uncommon  for  the  person  to  have  suffered  from  neuralgic  pains 
— perhaps  from  intense  headaches,  or  from  facial  neuralgia,  or 
from  pain  in  other  parts  of  the  body,  all  which  were  forebodings 
of  the  evil  to  come.  The  muscular  sense  is  especially  affected — 
exalted  at  first  so  as  to  give  a  false  feeling  of  great  bodily 
strength,  but  impaired  much  afterwards,  so  that  the  sufferer, 
having  lost  all  power  of  executing  the  more  delicate  and  complex 
movements,  is  quite  unaware  of  his  impotence,  and  deems 
himself  not  less  skilful  than  when  at  his  best  state.  Eeflex 
excitability  is  lessened  in  both  cerebral  and  spinal  nerves  as 
the  disease  advances ;  but  it  is  not  impaired  at  the  beginning, 
and  it  may  appear  to  be  even  increased  in  the  spinal  cord  when 
the  brain  is  affected  notably  and  it  is  not.  The  special  senses 
are  not  usually  affected  until  near  the  end,  when  smell  and  taste 
are  diminished  or  lost,  and  vision  fails.  Sometimes,  however, 
the  impairment  of  smeU  and  taste  shows  itself  much  earlier. 
Perversions  or  defects  of  the  organic  sensibilities  may  be  the 
cause  of  delusions  that  the  intestines  are  closed  or  destroyed. 
A  great  increase  of  sexual  desire  and  an  excited  display  of  it 
are  not  unfrequent  at  the  beginning  of  the  disease,  but  there  is 
not  corresponding  sexual  power ;  and  this  is  soon  quite  lost. 

The  bodily  nutrition  is  differently  affected  at  different  stages 
of  the  disease.  At  the  beginning  the  patients  often  lose  weight 
and  become  thin,  but  later  on,  particularly  when  they  reach  the 
stage  of  placid  dementia,  they  get  stout  and  flabby,  and  sores  or 
wounds  on  them  heal  remarkably  well.  At  a  still  later  stage, 
when  nervous  energy  is  nearly  extinguished,  bedsores  are  easily 
caused,  and  after  death  the  tissues  are  soft  and  flabby,  while  the 
bones,  and  especially  the  ribs,  are  softened  and  friable  so  as  to 
be  easily  broken. 

The  mental  disorder  which  goes  along  with  the  motor  impair- 
ment  is  remarkable   usually   for   an  extraordinary   feeling   of 


IX  ]  CLINICAL  GKOUPS  OF  MENTAL  DISEASE.  439 

elation  and  well-being  with  corresponding  delusive  ideas.  But 
here  also,  as  in  so  many  cases  of  insanity,  a  period  of  initial  de- 
pression often  goes  before  the  outbreak  of  excitement ;  a  period 
which  is  brief  and  transient  in  some  instances,  but  in  other 
instances  lasts  for  a  few  weeks.  It  is  a  state  in  which  the 
patient,  conscious  of  a  threatening  mental  trouble,  complains 
of  impairment  of  memory,  of  inability  to  think,  of  incapacity  to 
do  his  work,  sometimes  of  difficulty  to  pronounce  his  words, 
is  depressed  and  apprehensive,  and  perhaps  expresses  gloomy 
fears  that  he  will  go  mad.  He  is  willing  enough  to  consult  a 
doctor  now.  But  after  a  while  a  remarkable  change  takes  place 
in  his  feelings  and  ideas — from  the  depths  of  sadness  he  rises 
to  an  extravagant  pitch  of  elation :  he  is  in  a  state  of  exuberant 
joy,  "  hail  fellow  well  met "  with  everybody  ;  full  of  projects  to 
benefit  himself  and  mankind ;  reckless  in  spending  money,  all 
sense  of  the  value  of  which  he  seems  to  have  lost ;  eagerly  buys 
pictures  which  he  declares  to  be  Michael  Angelos  or  Raphaels, 
or  jewellery  and  other  things  which  he  does  not  need  and  cannot 
afford  to  pay  for;  breaks  out  into  sexual  excesses  that  are  quite 
foreign  to  his  natural  character;  and  rushes  into  extravagantly 
absurd  commercial  speculations  by  which  he  is  sure  he  will 
make  an  enormous  fortune.  If  pressed  to  see  a  doctor,  he  may 
consent  out  of  the  excess  of  his  geniality  and  his  gladness  to  talk 
of  his  great  schemes  to  everybody,  but  he  laughs  at  the  idea  of 
there  being  anything  the  matter  with  him  and  protests  that  he 
was  never  in  stronger  and  better  health  in  his  life.  Notable  is 
the  mental  weakness  which  prevents  him  from  seeing  through 
transparent  schemes  to  divert  him  from  his  projects  and  renders 
it  comparatively  easy  to  approach  and  manage  him.  With  the 
ordinary  maniac,  who  presents  at  first  somewhat  similar  but 
less  extreme  symptoms,  great  caution  and  address  are  necessary 
to  avoid  rousing  his  suspicion  and  anger;  but  it  is  commonly' 
easy  to  approach  the  general  paralytic,  who  hardly  asks  his  in- 
terviewer who  he  is  and  why  he  has  come,  or,  if  he  does,  is  easily 
satisfied  with  almost  any  sort  of  explanatory  or  apologetic 
answer,  shows  no  suspicion  or  resentment,  hastens  to  tell  him  of 
his  great  projects,  perhaps  offers  to  make  his  fortune  for  him, 
and  invites  him  when  he  leaves  to  come  again  soon. 


440  PATHOLOGY  OF  MIND.  [.::iiAP. 

As  tlie  mental  disorder  increases  it  issues  in  the  most  extrava- 
gant delusions  conceivable  of  wealth,  power,  or  grandeur  :  he  can 
talk  all  the  languages  of  the  world  ;  has  a  superb  musical  voice, 
can  siug  better  than  Mario  ever  could,  and  will  make  a  thousand 
pounds  a  night  on  the  stage ;  is  as  strong  as  Hercules,  an  accom- 
plished athlete,  and  can  perform  muscular  feats  which  no  other 
man  ever  could  ;  is  possessed  of  inexhaustible  wealth  and  gives 
away  cheques  for  millions  to  any  one  who  asks  for  them ;  is  a 
duke,  a  prince,  a  king,  or  sometimes  even  king  of  kings,  and  will 
confer  dukedoms  or  greater  honours  with  lavish  generosity ;  is 
going  to  marry  a  princess  or  a  queen,  or  to  have  a  harem  of  all 
the  finest  women  in  the  world.  There  is  no  limit  to  the  absurd 
extravagance  of  his  delusions,  v/hich  he  will  utter  placidly  with- 
out the  least  show  of  feeling,  or  with  only  a  feeble  smile  of 
self-complacence,  or  with  a  burst  of  imbecile  laughter.  When 
he  is  sent  to  an  asylum  he  is  delighted  with  everything,  his 
accommodation  is  capital,  and  he  is  determined  to  buy  the  place 
and  to  make  a  great  palace  of  it.  His  great  mental  weakness  is 
shown  in  an  extreme  loss  of  memory,  in  glaring  inconsistency 
between  his  ideas  and  conduct,  or  even  between  his  gross  delu- 
sions themselves,  and  in  his  fatuous  insensibility  to  ridicule ;  he 
is  going  to  marry  a  princess,  forgetting  that  he  has  a  wife,  whom 
nevertheless  he  acknowledges  when  she  visits  him  ;  he  gives 
cheques  for  millions  at  the  same  time  that  he  begs  for  a  little 
tobacco ;  he  cannot  perceive  the  insanity  of  other  patients  in  the 
asylum,  however  outrageous  it  is,  and  is  insensible  to  their 
ridicule  of  his  absurd  pretensions.  In  the  Edinburgh  asylum 
was  a  general  paralytic  under  Dr.  Skae's  care  who  thought 
himself  king  of  kings  and  had  other  characteristic  delusions 
of  grandeur,  and  who  was  most  lavish  in  presenting  millions  of 
money.  Before  he  was  sent  to  the  asylum  he  had  £1  in  the 
savings  bank,  the  interest  of  which  had  risen  to  3s.  Ad.  He 
always  kept  this  sum  distinct  from  the  immense  sums  which  he 
believed  he  had  in  the  Bank  of  Scotland,  and  would  never  part 
with  a  penny  of  it.  IMoreover,  he  calculated  interest  at  twenty- 
five  per  cent,  on  his  supposed  wealth  and  made  a  muddle  of  it, 
but  he  calculated  the  interest  on  his  actual  property  at  five  per 
cent,  and  correctly. 


IX.]  CLINICAL  GROUPS  OF  MENTAL  DISEASE.  441 

Outbreaks  of  acute  maniacal  excitement  accompaiicd  by 
violent  resistance  to  control  occur  frequently  during  the  pro- 
gress of  the  disease,  each  of  them  being  usually  followed  by  a 
notable  increase  of  the  mental  weakness ;  and  it  is  not  unusual 
for  intervals  of  melancholic  depression  and  gloomy  irritability  to 
interrupt  from  time  to  time  the  usual  strain  of  exaltation.  As 
the  end  approaches,  the  dementia  is  extreme ;  there  is  scarcely 
a  sign  of  intelligence  noticed,  and  the  face  is  an  expressionless 
mask  across  which  flickers  now  and  then  the  broken  ripple  of  a 
smile,  or  it  is  fixed  in  a  sardonic  grin  ;  but  even  in  the  last  stage 
of  mental  disorganisation,  when  delusions  are  shattered,  the  few 
words  which  he  mutters  may  bear  witness  to  the  wreck  of  his 
grand  notions  about  carriages,  diamonds,  millions  of  pounds. 

This  is  the  form  which  general  paralysis  most  commonly 
takes,  and  which  is  suggested  when  its  name  is  mentioned,  but 
there  are  considerable  varieties  in  the  mental  symptoms  in  some 
cases.  For  example,  in  one  form  there  is  a  steady  decline  of 
intelligence  from  the  first  without  any  marked  delusions — in 
fact,  a  gradually  increasing  stupidity  of  a  good-natured  sort, 
although  the  prevailing  good-humour  is  apt  to  be  interrupted 
from  time  to  time  by  periods  of  depression  or  by  intervals  of 
irritable  and  gloomy  temper.  In  another  variety  painful  delu- 
sions of  an  extreme  character  with  corresponding  depression 
prevail  throughout  the  course  of  the  disease :  the  patient  pro- 
tests that  he  is  blind  and  cannot  see,  that  he  is  completely  deaf, 
that  his  throat  is  closed  so  that  he  cannot  swallow  any  food, 
that  he  has  no  stomach,  that  his  intestines  have  passed  from 
him,  that  he  is  dying  or  is  actually  dead.  I  have  observed  in  one 
instance  the  disease  begin  with  all  the  characteristic  symptoms 
of  elation,  so  that  no  one  who  saw  the  patient  had  the  least 
doubt  of  its  nature,  and  after  a  time  pass  into  the  melancholic 
form,  the  exalted  delusions  being  superseded  by  the  sad  delusions 
that  he  could  not  swallow  and  had  no  inside  and  by  refusal  of 
food  in  consequence.  In  this  state  the  patient  has  remained  for 
years,  the  disease  making  no  progress.  Whether  the  disease 
shall  take  the  exalted  or  the  depressed  form  in  a  particular 
case  is  probably  in  the  main  a  question  of  original  tempera- 
ment :  a  person  who  is  self-confident,   boastful,  proud  of  his 


442  PATHOLOGY  OF  MIND.  [chap 

powers  and  possessions,  prone  to  ambitious  day-dreams,  confi- 
dent that  his  geese  are  all  swans,  is  likely  to  become  exalted, 
whereas  a  person  of  the  opposite  temperament  will  be  more 
likely  to  fall  melancholic.  Dr.  Clouston  thinks  he  has  noticed 
an  intimate  relationsliip  between  general  paralysis  with  depres- 
sion and  tuberculosis,  and  believes  that  the  melancholic  variety 
will  be  found  chiefly  among  those  who  are  also  phthisical. 

The  course  of  the  disease  is  towards  death,  an  end  which  it 
usually  reaches  within  two  or  three  years  from  its  commence- 
ment.    It  is  extremely  doubtful  whether  an  instance  of  real 
recovery  has  ever  taken  place,  although  such  a  one  has  been 
put  on  record  from  time  to  time.     I  have  read  in  a  medical 
journal  the  exultant  report  of  the  complete  recovery,  so-called, 
of  a  gentleman  who  however  died  not  long  afterwards  with 
the   usual  symptoms  of  general  paralysis.     What  happens  in 
these  cases  is  that  when  the  patient  is  placed  under  proper 
treatment  and  taken  away  from  occasions  of  excitement,  the 
progress   of   the   disease  is  arrested,   the  symptoms  disappear 
almost  completely,  and  it  is  hoped  that  he  is  recovered ;  but 
it  is  seldom,  if  ever,  a  real  recovery,  for  after  a  time  the  symp- 
toms come  back — very  soon  probably  if  control  has  been  re- 
moved— and  the  disease  goes  through  its  ordinary  course.    These 
symptomless  intermissions  are  certainly  so  long  in  some  few 
cases  that  the  duration  of  it  is  prolonged  much  beyond  the 
usual   two   years.     The  melancholic  cases  almost  always  last 
lonser  than   the  exalted,  and   the  disease  runs  a  slower    and 
quieter  course  in  women.     In  the  more  advanced  stages,  when 
its  progress  has  made  it  plain  what  its  early  end  will  be,  apo- 
plectiform or  epileptiform  attacks  with  loss   of  consciousness, 
and  with  or  without  convulsions,  occur  from  time  to  time ;  they 
soon  pass  off,  leaving  behind  them  probably  more  or  less  para- 
lysis or  convulsion  of  one  side,  which  itself  again  after  a  few 
days   disappears  in   great  part  or  entirely ;  but  after  each  of 
these  attacks  the  general  feebleness  of  mind  and  body  is  found 
to  be  increased.      They  are  often   preceded   by  symptoms  of 
determination  of  blood  to  the  head,  and  by  more  or  less  mental 
excitement,  and  during  them  there  is  great  heat  of  body,  the 
temperature  of   which  may  rise  several  degrees.     Death  may 


IX.]  CLINICAL  GEOUPS  OF  MENTAL  DISEASE.  443 

take  place  in  one  of  these  attacks,  or  soon  after  one  ;  or  it  is  the 
result  of  gradual  exhaustion,  large  bedsores  forming  notwith- 
standing the  best  care,  and  some  such  disease  as  diarrhoea, 
bronchitis,  or  pneumonia  helping  to  make  an  end  of  the 
miserable  spectacle.  The  evening  temperature  is  usually  higher 
than  the  morning  temperature  in  general  paralysis  ;  a  great  rise 
thereof — as  much  perhaps  as  5 '8°  sometimes — precedes  and 
always  accompanies  the  excited  and  epileptiform  attacks,  abating 
only  gradually  after  them ;  and  the  occurrence  of  pulmonary 
complications  or  of  hectic  exhaustion  is  marked  by  an  increased 
temperature.^ 

Such  are  the  symptoms  of  a  remarkably  definite  group  of 
cases  in  which  mental  impairment  and  motor  paralysis  proceed 
together  with  pretty  equal  steps.  As  Bayle  pointed  out  long  ago, 
no  one  can  fail  to  observe  in  them  an  interesting  resemblance 
to  those  of  drunkenness  ;  the  exaltation  of  ideas  and  the  good 
humour  at  the  outset,  the  incoherence  of  ideas  and  embarrassed 
speech  later  on,  and  finally  the  inability  to  walk  properly,  the 
loss  of  sensibility,  and  the  increasing  stupidity  are  common  to 
both  conditions  and  render  it  probable  that  alcohol  produces 
a  rapid  sequence  of  temporary  morbid  changes  in  the  nerve- 
centres  very  like  that  which  is  slowly  WTOught  in  general 
paralysis.  Certainly  there  are  some  persons  who  when  drunk 
present  an  exact  miniature  picture  of  the  disease.  Definite  and 
characteristic  as  its  symptoms  mostly  are,  it  ought  not  to  be 
supposed  that  it  is  marked  off  from  all  other  forms  of  mental 
disorder  by  a  barrier  which  is  never  crossed.  There  are  cases 
of  syphihtic  dementia  which  look  so  like  it  that  one  is  decided 
what  to  call  them  by  the  result  only.  Again,  some  cases  of 
the  so-called  circular  insanity,  where  melancholic  depression 
follows  a  period  of  mental  excitement  marked  by  extreme  exalta- 
tion of  feeling,  ideas,  and  conduct,  may  be  mistaken  for  it  in 
the  first  instance;  and  it  might  perhaps  be  fairly  argued  that  some 
of  the  supposed  genuine  cases  of  general  paralysis  in  which 
melancholy  has  taken  the  place  of  mania,  and  the  duration  of 
the  disease  has  been  much  prolonged,  were  really  examples  of 

1  Journal  of   Mental  Science,  April,   1868,    Dr.  Clouston.     Ihid.    1872, 
Dr.  Mickle. 


444  PATHOLOGY  OF  MIND.  [cdap. 

circular  insanity.  Lastly,  as  I  have  pointed  out  already,  all  the 
motor  symptoms  of  the  disease  may  occur  and  go  on  to  death, 
without  any  marked  mental  symptoms  or  with  such  symptoms 
noticeable  only  for  a  short  time  before  the  fatal  end.  Diseases 
are  not  morbid  entities,  but  more  or  less  definite  deviations  from 
healthy  life ;  in  a  particular  case,  therefore,  it  may  chance  that 
the  usual  limits  of  deviation  are  not  reached,  or  are  exceeded, 
or  are  irregular  in  character,  insomuch  that  two  allied,  or, 
as  we  might  call  them,  adjacent  diseases,  have  their  symptoms 
intermingled  and  are  no  longer  exactly  distinguishable. 

Epileptic  Insanity. 

The  symptoms  of  the  mental  derangement  which  is  met  with 
in  connection  with  epilepsy  are  those  of  mania,  of  monomania, 
and   of  dementia.     Most   marked  are  the  symptoms  of  acute 
mania,  which  generally  comes  on  after  an  epileptic  fit  or  a  suc- 
cession of  epileptic  fits,  and  is  of  a  very  violent  and  destructive 
character,  showing  itself  in  a  blind  impulsive  fury  during  which 
the  patient  is  scarcely,  if  at  all,  conscious  of  his  real  surround- 
ings and  not  in  the  least  affected  by  any  exhibition  of  restrain- 
ing power.      Most   maniacs   yield   something  to   the  show  of 
authority  when  it  is  great  enough,  or  evince  a  transient  appre- 
ciation of  what  is  said  to  them,  but  the  epileptic  maniac  takes 
not  the  least  notice  of  remonstrance,  entreaty,  or  control;  he 
yells   and   shrieks,   knocks   his   body   about   violently,  rushes 
furiously,  strikes  whatsoever  or  whomsoever   is    in    his    way, 
destroys   blindly — is,   in  truth,   sometimes   a   mere    embodied 
fury ;  and  when  he  comes  to  himself  he  is  not  conscious  or  has 
only  the  haziest   memory  of  what  he  has  done.     Before  the 
attack  he  is  often  extremely  irritable,  silent  and  surly,  morosely 
suspicious,  and  is  apt  to  strike  suddenly  or  otherwise  injure 
any  unoffending  person  who  comes  near  him — in  a  mood  which 
impels  him  to  an  act  of  violence  on  the  least  occasion;  and  during 
it  he  makes  the  most  desperate  attacks  without  provocation  and 
without  warning.     The  storm  is  usually  over  in  a  few  hours, 
but  it  may  last  a  few  days  ;  when  it  is  past  the  patient  is  left 
for  a  short  time  in  a  state  of  great  mental  confusion,  a  sort  of 


IX.]  CLINICAL  GllOUPS  OF  MENTAL  DISEASE.  445 

transitory  dementia,  and  then  comes  to  himself,  remaining  quite 
sane  perliaps  until  the  next  epileptic  attack. 

In  some  cases  of  epileptic  insanity  the  mental  symptoms  are 
those  of  monomania.  The  surly,  irritable,  suspicious  mood  gets 
expression  in  a  delusion  that  is  in  keeping  with  it,  as,  for  example, 
that  some  one  threatens  or  attempts  his  life,  and  he  is  then 
a  most  dangerous  person  because  very  apt  to  defend  or  revenge 
liimself  in  a  violent  way.  Perhaps  a  vivid  hallucination  of 
sight  or  of  hearing,  in  harmony  with  the  suspicious  mood  or 
delusion,  starts  forth  and  determines  or  strengthens  the  impulse 
to  retaliation.  The  morbid  impulses  may  be  either  homicidal 
or  suicidal,  but  are  more  often  homicidal  than  suicidal,  conform- 
able to  what  we  know  of  the  great  energy  of  epileptics.  It  is 
not  always  possible  to  connect  the  homicidal  impulse  or  act 
with  any  definite  delusion ;  it  seems  to  be  sometimes  nothing 
more  than  a  mere  blind  impulse  to  destroy ;  at  the  same  time 
it  is  always  difficult  to  be  sure  that  there  was  not  some  obscure 
and  vague  suspicion  or  delusion  at  the  time,  of  which  the 
person  can  give  no  clear  account  afterwards,  any  more  than  the 
dreamer  can  of  some  of.  the  strange  impulses  of  his  dream. 
The  mental  disorder  is  usually  periodical  at  first,  like  the  fits, 
coming  on  in  connection  with  them,  and  the  patient  during 
the  intervals  between  them  is  amiable,  industrious,  and  fairlv 
rational,  although  weakened  in  mind. 

In  other  cases  the  disorder  takes  the  form  of  good  humour 
and  exaltation  and  is  then  exhibited  in  an  excessive  vanity 
wdth  corresponding  exalted  delusions,  which  are  oftentimes  of 
a  religious  character.  It  is  w^orthy  of  notice,  as  Dr.  HowTlen 
has  pointed  out,  how  much  addicted  at  certain  periods  the 
epileptic  lunatic  in  an  asylum  is  to  reading  his  Bible,  and 
how  frequently  he  evinces  some  such  delusion  as  that  he  is 
actually  God,  Christ,  or  some  great  personage  of  Scripture,  or 
that  he  has  had  revelations  from  one  of  these  great  personages. 
There  is  no  doubt  that  immediately  before  an  epilex^tic  fit,  or 
during  the  epileptic  trance  before  normal  consciousness  is 
restored,  these  patients  do  sometimes  see  visions,  having  very 
vivid  hallucinations,  and  that  the  remembrance  of  what  they 
saw  or  heard  may  remain  as  positive  delusion  afterwards.     It 


446  PATHOLOGY  OF  MIND.  [chap. 

is  a  fact  of  much  interest  in  relation  to  the  origin  of  certain 
religious  creeds,  the  promulgators  of  which,  being  epileptic,  had 
visions  or  revelations  which  they  and  their  disciples  deemed  to 
be  supernatural.  Anne  Lee,  the  founder  of  the  so-called  Shakers, 
an  epileptic,  had  visions  of  the  Saviour,  who,  she  declared, 
"  became  one  with  her  in  body  and  spirit."  Swedenborg,  who 
professed  to  receive  manifold  holy  revelations  and  to  have 
habitual  intercourse  with  the  inhabitants  of  heaven  and  hell^ 
suffered  from  seizures  which  were  closely  akin  to,  if  they  were 
not  actually,  epilepsy.  Mahomet  was  epileptic,  and  it  is  not 
improbable  that  the  ecstatic  trances  in  which  he  saw  the  angel 
Gabriel,  and,  like  Swedenborg,  visited  heaven,  were  of  that 
nature :  and  it  has  been  surmised  that  the  trance  which  con- 
verted Saul  the  persecutor  into  Paul  the  Apostle  of  the  Gentiles 
was  of  a  similar  character.  At  the  present  day  the  Siberian 
Schamans  or  medicine  men,  who  pretend  to  intercourse  with  the 
invisible  powers  and  with  the  spirits  of  the  dead,  and  to  other 
dealings  with  supernatural  powers,  working  themselves,  like  the 
priests  of  the  ancient  Delphic  oracle,  into  a  state  of  frenzy  in 
which  they  foam  at  the  mouth  and  n,re  convulsed,  prefer  always 
for  pupils  of  their  mysteries  boys  who  are  subject  to  epileptic 
attacks.^  It  cannot  be  disputed  that  some  epileptics  have  that 
function  of  mind  which  we  call  imagination  strongly  developed 
in  the  lower  walks  of  its  exercise,  and  that  in  certain  conditions 
of  excitement  it  may  reach  an  extraordinary  activity  of  a  quite 
involuntary  kind.  The  interesting  chapter  of  human  history 
has  yet  to  be  written  which  shall  set  forth  the  relations  between 
alleged  supernatural  experiences  and  the  abnormal  functions  of 
the  nervous  system,  and  again  between  the  divine  fury  or  so- 
called  inspired  enthusiasm  of  the  prophet  (6  Oeoq  iv  vf^cy)  and 
that  extraordinary  activity  of  its  normal  functions  in  which  the 
whole  affective  and  highest  intellectual  energies  of  the  individual 
are  united  in  some  great  achievement. 

Hallucinations  of  all  the  senses  are  more  frequent  and  more 
vivid  in  epileptic  than  in  any  other  form  of  mental  disorder. 
During  a  paroxysm  of  its  blind  fury  all  the  senses  are  in  tur- 
bulent commotion ;  there  are  roaring  noises  in  the  ears,  bright 
*  Oscar  Peschel,  Vulkerhiinde,  p.  275. 


CLINICAL  GROUPS  OF  MENTAL  DISEASE.  447 

or  crimson  lialos  or  black  cloud-like  spectra  before  the  eyes, 
stinking  or  stifling  sulphurous  odours  in  the  nostrils,  fearfully 
poisonous  tastes  in  the  mouth.  In  the  less  acute  and  more 
partial  forms  of  epileptic  insanity  there  are  commonly  chronic 
hallucinations  of  the  same  sort ;  the  person  hears  distinctly  a 
voice  which  insults  him  or  conmiands  him  peremptorily  to  do 
some  deed,  or  sees  actual  fissures  which  exhort  or  threaten  him, 
or  smells  poisonous  fumes;  and  these  false  perceptions  of  the 
senses  may  abide  through  the  intervals  between  the  fits,  as  well 
as  occur  immediately  before  them.  One  patient  who  consulted 
me  used  ahvays  to  hear  before  a  fit  a  noise  in  the  ear  which  w^as 
just  like  the  puffing  of  a  locomotive  engine  wdien  it  starts;  the 
noise  lasted  long  enough  to  give  him  time  to  make  preparations 
for  the  fit  which  it  heralded — for  example,  to  walk  into  a  house, 
take  off  his  collar,  and  lie  down.  Dr.  Gregory  has  recorded  the 
case  of  a  gentleman  in  whom  the  paroxysm  was  preceded  by 
the  apparition  of  an  old  woman  in  a  red  cloak  leaning  on  a 
crutch,  who  appeared  to  come  close  up  to  him  and  to  strike 
him  on  the  head  with  her  crutch,  when  he  instantly  fell  down 
unconscious.  A  few  years  ago  a  labourer  in  the  Chatham  dock- 
yard suddenly,  without  provocation,  split  the  skull  of  a  labourer 
near  him  wdth  an  adze ;  he  had  formerly  been  confined  in  an 
asylum  on  account  of  epilepsy  and  mental  disorder;  and  it 
came  out  after  his  trial,  when  he  had  been  placed  in  an  asylum, 
that  he  believed  he  had  received  the  Holy  Ghost  some  time 
before  the  homicide,  that  it  had  come  to  him  like  a  bright  light, 
and  that  his  own  eyes  had  been  taken  out  and  balls  of  fire  put 
in  their  places.  In  th'e  well-known  aura  epilcptica — the  abnormal 
sensation  which,  appearing  to  spring  from  some  internal  or  ex- 
ternal spot  of  the  body,  so  often  precedes  an  epileptic  fit — we 
have  a  striking  example  of  the  disturbance  of  general  sensation 
and  organic  sensibility ;  and  I  have  no  doubt  that  a  more 
general  and  violent  disorder  of  these  general  functions  of 
organic  sense  during  a  paroxysm  of  epileptic  fury  is  a  main 
condition  of  the  person's  loss  of  feeling  of  personal  identity, 
and  of  the  remarkable  unconsciousness  of  wdiat  he  has  done 
daring  the  attack.  For  the  time  being  the  intimate  physio- 
logical sympathy  and  synergy  of  the  organs  of  the  body,  by 
20 


448  PATPIOLOGY  OF  MIND.  [chap. 

virtue  of  wliich  it  is  an  organism,  and  which,  as  I  have  else- 
where argued,  are  the  real  foundation  of  the  ego,  are  suspended ; 
it  is  a  chaos  of  abnormal  sensations  which  are  translated  imme- 
diately in  a  chaos  of  irregular  movements.  Not  unworthy  of 
notice  in  this  connection  is  it  that  loss  of  consciousness  has 
been  observed  to  occur  soonest  in  those  epilepsies  in  which  the 
aura  proceeds  from  the  epigastrium,  just  as  the  most  distressing 
paroxysms  of  helpless  anguish  and  apprehension  are  witnessed  in 
those  cases  of  melancholia  in  which  a  morbid  sensation  appears 
to  rise  in  the  epigastriurh  and  mount  thence  to  the  head. 

Another  form  which  epileptic  insanity  takes  is  dementia.  It 
is  the  termination  which  it  gradually  reaches  when  it  is  not 
cured ;  as  the  paroxysms  of  derangement  recur,  the  memory 
fails,  the  feelings  are  deadened  and  desires  wane,  the  sensations 
are  dull  and  slow,  the  intellect  becomes  weaker  and  weaker, 
and  there  ensues  a  condition  of  dementia  which  differs  only 
from  the  dementia  that  follows  other  forms  of  insanity  in  the 
greater  frequency  of  its  hallucinations  and  of  its  outbursts  of 
irrational  and  impulsive  violence. 

In  all  these  forms  of  insanity  the  outlook  is  bad,  and  it  is  so 
because  we  cannot  as  a  rule  cure  the  epilepsy.  Could  we  do 
that  soon  we  might  fairly  expect  a  good  result,  for  a  considerable 
mental  improvement  has  taken  place  in  a  person  far  gone  in 
dementia,  when  by  some  happy  chance  or  measure  of  treatment 
the  fits  have  been  stopped.  Indeed,  the  mental  derangement 
may  be  looked  upon  as  the  dark  shadow  of  the  epilepsy  which 
will  disappear  usually  when  it  disappears ;  a  fact  which  puts  it 
in  a  somewhat  special  clinical  category,,seeing  that  we  could  not 
justly  look  for  recovery  from  a  similar  monomaniacal  or  de- 
mented form  of  insanity  when  there  was  no  epilepsy  to  complicate 
matters.  A  few  striking  cases  are  recorded  in  which  epilepsy, 
due  to  a  depressed  or  damaged  portion  of  the  cranium  by  injury, 
was  cured  by  the  surgical  removal  of  the  injured  piece  of  bone, 
and  the  accompanying  insanity  cured  at  the  same  time.  The 
administration  of  large  doses  of  bromide  of  potassium  will  sus- 
pend and  sometimes  cure  the  fits  at  an  early  stage,  and  wdll 
much  lessen  their  frequency  even  in  advanced  cases;  but  I 
cannot  say  that  I  have  observed  permanent  benefit  from  its 


IX.]  CLINICAL  GROUPS  OF  MENTAL  DISEASE.  449 

persevering  use  in  cases  of  long  standing  epilepsy  with  mental 
disorder.  Certainly  the  attacks  may  be  suppressed  for  a  time 
by  it,  but  they  seem  to  accumulate  in  the  system  until  it  is 
charged  with  explosive  forces — very  much  as  a  Leyden  jar  is 
charged  with  electricity — and  to  burst  out  eventually  in  longer 
paroxysms  of  fearful  excitement  and  violence,  insomuch  that  it 
has  seemed  better  on  the  whole  to  suffer  them  to  have  their 
natural  course  unchecked.  Nor  is  the  least  good  done  in  these 
cases  by  attempts  to  stifle  or  cut  short  the  maniacal  excitement 
by  the  use  of  large  doses  of  chloral,  opium,  or  any  other  narcotic 
drug.  The  patient  may  commonly  be  overpowered  by  the  drug 
and  thrown  into  a  stuporous  sleep  of  an  hour  or  two  if  the  doses 
given  be  large  enough,  but  he  will  be  likely  to  be  in  a  worse 
state  of  excitement  when  he  wakes,  and  the  paroxysm  will  last 
longer  in  the  end. 

Insanity  of  Pubescence. 

The  great  changes  which  take  place  in  the  nervous  system  at 
puberty  coincidently  with  the  development  of  the  reproductive 
organs  make  themselves  known  by  a  complete  revolution, 
or,  more  correctly  speaking,  evolution,  of  the  mind.  New 
ideas  and  feelings  and  impulses  come  to  the  individual,  he 
knows  not  whence  or  how ;  there  is  a  decided  emotional 
ground  tone  of  purely  subjective  origin,  showing  itself  in 
vague  longings  and  pleasing  moods  of  melancholy,  and  craving 
for  something  objective  to  attach  itself  to.  This  strongly  sub- 
jective mood  necessarily  implies  a  condition  of  somewhat  un- 
stable equilibrium  of  mind,  which  is  not  then  in  exact  and 
adequate  adjustment  to  its  surroundings,  and  may  well  become 
critical.  In  some  instances  the  physiological  evolution  of  puberty 
passes  into  a  pathological  revolution.  Moreover,  as  it  is 
the  unfailing  tendency  of  the  mind  to  project  its  affections 
outwards  and  to  transfer  them  to  objects  as  qualities — 
to  exteriorise  its  states  as  qualities — a  person  at  puberty 
who  is  possessed  with  a  new  feeling  w^hicli  craves  for  external 
attachment  is  apt  to  invest  unfit  objects  with  qualities  which 
they  are  altogether  destitute  of,  or  even  to  create  the  object  in 


450  PATHOLOGY  OF  MIND.  '  [chap. 

extreme  cases.  For  these  reasons  it  is  tliat  the  development  of 
puberty  is  now  and  then  the  occasion  of  an  outbreak  of  mental 
disorder,  especially  where  there  is  a  strong  predisposition  to 
such  disorder.  Girls  are  more  liable  to  suffer  at  this  period, 
I  think,  than  youths ;  and  it  is  not  difficult  to  understand  why. 
In  the  first  place,  the  affective  life  is  more  developed  in  propor- 
tion to  the  intellect  in  the  female  than  in  the  male  sex,  and  the 
influence  of  the  reproductive  organs  upon  mind  more  powerful ; 
secondly,  the  range  of  activity  of  women  is  so  limited,  and 
their  available  paths  of  work  in  life  so  few,  compared  with  those 
which  men  have  in  the  present  social  arrangements,  that  they 
have  not,  like  men,  vicarious  outlets  for  feeling  in  a  variety  of 
healthy  aims  and  pursuits ;  in  the  third  place,  social  feelings 
sanction  tacitly  for  the  one  sex  an  illicit  indulgence  which  is 
utterly  forbidden  to  the  other ;  and,  lastly,  the  function  of  men- 
struation, which  begins  at  puberty  in  women,  brings  with  it 
periodical  disturbances  of  the  mental  tone  which  border  closely 
on  disease  in  some  cases,  while  the  irregularities  and  suppres- 
sions to  which  it  is  liable  from  a  variety  of  mental  and  bodily 
causes  may  affect  the  mind  seriously  at  any  time. 

I  know  not  that  there  is  anything  in  the  insanity  which  occurs 
at  this  period  so  characteristic  as  to  enable  me  to  give  a  special 
description  of  it.  It  may  have  the  complexion  of  mania  or  of 
melancholia.  In  the  former  case,  the  mental  excitement,  which 
perhaps  breaks  out  rather  suddenly,  is  not  of  a  very  acute 
character,  being  shown  rather  in  a  ludicrous  exaltation  of  the 
natural  self-conceit  of  that  age,  in  excitedly  pert  and  extrava- 
gant talk,  in  the  absence  of  all  diffidence  of  thought,  feeling, 
and  of  demeanour,  and  in  restless,  absurd,  and  mischievous  acts 
which,  having  much  the  air  of  being  wilful  and  capricious,  are 
apt  to  be  called  hysterical.  ^Nevertheless,  when  we  proceed  to 
observe  them  carefully,  we  perceive  that  they  are  too  un- 
reasoning and  automatic  to  be  entirely  wilful.  They  illustrate 
that  mixture  of  the  voluntary  and  involuntary  which  is  often 
observed  at  the  beginning  of  mental  disorder  ;  which  there  would 
be  no  difficulty  in  recognising  were  it  not  for  the  metaphysical 
conception  of  will  as  an  immaterial  entity ;  and  which  I  know 
not  how  better  to  describe  than  by  such  incongruous  term  as 


ix.J  CLINICAL  GROUPS  OF  MENTAL  DISEASE.  451 

"  involuntarily  wilful."  The  attacks  of  mental  excitement  may 
be  paroxysmal,  the  person  being  apparently  quite  well  in  the 
intervals  between  them,  and  they  are  sometimes  accompanied 
by  movements  which  seem  to  be  of  a  quasi-spasmodic  or  choreic 
nature,  such  as  a  continuous  jerking  of  the  body  in  a  peculiar 
way,  strange  motions  of  the  hands  and  arms,  an  extraordinary 
grimacing,  fits  of  crawling  on  the  floor,  quasi-somnambulistic 
seizures,  and  the  like. 

In  other  cases  the  symptoms  are  those  of  melancholia ;  the 
person  becomes  dull  and  listless,  is  silent  and  moody,  relin- 
quishes occupations  and  pleasures,  weeps  perhaps  without  ap- 
parent reason,  gets  an  unfounded  notion  that  he  or  she  is  an 
object  of  dislike,  or  of  suspicion,  or  of  persecution,  or  has  done 
something  very  wrong,  tears  clothing  in  a  seemingly  wilful  and 
perverse  way,  and  perhaps  makes  objectless  starts  away  from 
home,  or  absurd  and  bungling  attempts  at  suicide.  Eecovery 
usually  takes  place  in  these,  as  in  the  maniacal  cases,  when 
suitable  treatment  is  put  in  force,  but  a  similar  attack  is  not 
unlikely  to  occur.  Where  hereditary  predisposition  is  strong, 
and  of  a  bad  type,  the  disease  may  go  on  from  year  to  year,  the 
mind  becoming  gradually  weaker,  until  it  passes  eventually  into 
dementia;  a  dementia,  however,  which  differs  from  ordinary 
dementia  in  the  evidence  which  there  is  for  a  lonsr  time  of  clear 
understanding  if  the  person  can  only  be  moved  to  exercise  it, 
notwithstanding  the  extreme  apathy  of  feeling,  deadness  of  will, 
and  insanity  of  conduct  which  are  shown.  It  is,  in  fact,  more 
a  moral  than  an  intellectual  dementia. 

In  order  to  treat  such  patients  successfully,  it  is  necessary  in 
most  cases  to  remove  them  from  home  and  the  care  of  their 
parents,  who,  with  the  best  intentions,  either  fail  to  manage 
them  properly  or  positively  mismanage  them,  and  to  put  them 
under  the  care  of  some  one  with  whom  their  morbid  outbreaks 
make  no  commotion,  and  who  will  exercise  systematically  a 
kind  and  thoughtful  but  firm  control.  And  that  is  a  course 
which  is  seldom  adopted  as  soon  as  it  ought  to  be,  if  it  is 
adopted  at  all ;  sympathetic  parents  of  a  like  constitutional  type 
are  apt  to  declare  earnestly  that  their  son  or  daughter  is 
peculiarly  sensitive,  and  that  they  are  sure  it  would  have  the 


452  PATHOLOGY  OF  MIND.  [chap. 

worst  effect  "upon  tliem  to  send  them  away  from  home,  and  so 
let  the  favourable  opportunity  of  early  cure  go  by.  No  marvel 
that  it  is  so  since  those  who  instinctively  keep  them  in  the 
morbid  train  are  those  who  bred  in  them  the  disposition  to  it. 

The  difficulty  of  giving  an  exact  clinical  picture  of  the 
symptoms  of  insanity  of  pubescence,  of  marking  distinctly  the 
territory  which  it  occupies,  so  that  all  men  may  know  it,  is 
heightened  by  its  frequent  complication  with  self-abuse  and 
the  mental  derangement  which  results  therefrom.  This  vice  is 
particularly  apt  to  befall,  and  particularly  injurious  in,  persons 
who  have  the  neurotic  temperament,  for  in  them  the  sensibility 
is  more  acute  and  urgent,  the  power  of  control  feeble  and 
sjoasmodic  in  its  exercise,  and  the  consequence  of  the  self- 
indulgence  specially  exhausting  and  harmful.  In  young  women, 
again,  the  mental  disturbance  that  occurs  in  connection  with 
pubescence  is  often  mixed  up  with  that  which  is  the  effect  of 
disordered  and  suppressed  menstruation,  so  that  it  is  not  prac- 
ticable to  distinguish  them.  In  the  present  state  of  knowledge 
it  would  perhaps  be  more  satisfactory  to  make  a  large  group  of 
the  cases  of  mental  disorder  which  attest  the  operation  of  the 
reproductive  organs  upon  mind,  and  to  be  then  content  to  in- 
dicate varieties  rather  than  to  attempt  to  describe  their  features 
exactly.  It  should  be  clearly  borne  in  mind  with  respect  to 
these,  as  with  respect  to  all  other  varieties  of  insanity,  that  the 
most  important  factor  in  the  determination  of  their  special 
features  is  not  the  supposed  bodily  cause  nor  the  actual  bodily 
condition,  but  the  particular  mental  character  of  the  individual, 
as  built  up  by  inheritance,  education,  and  experience. 


Insanity  of  Self- ah  use. 

The  most  striking  features  in  this  variety  of  mental  derange- 
ment are  the  intense  selfishness  and  self-conceit  that  are  shown. 
The  patient  is  completely  wrapped  up  in  self,  egotistically  in- 
sensible of  the  claims  of  others  upon  him  and  of  his  duties  to 
them,  hypochondriacally  occupied  with  his  sensations  and  his 
bodily   functions,    abandoned    to    indolent    and    solitary   self- 


IX.]  CLINICAL  GEOUPS  OF  MENTAL  DISEASE.  453 

brooding;  he  displays  a  vanity  and  self-sufficiency  quite  un- 
becoming his  age  and  position ;  exacts  the  constant  indulgence 
of  others  without  the  least  thought  of  obligation  or  gratitude, 
and  is  apt,  if  he  gets  not  the  consideration  which  he  claims,  to 
declare  that  his  family  are  unfeeling  and  do  not  understand 
him,  or  are  actually  hostile  to  him.  They  meanwhile  urge  him 
to  apply  himself  to  some  work,  seeing  no  reason  why  he  should 
not,  but  in  vain ;  he  may  talk  largely  of  projects  engendered  of 
his  conceit,  but  he  is  either  too  ill  to  attempt  to  work,  he  asserts, 
or  the  work  which  is  recommended  to  him  he  rejects  con- 
temptuously as  unsuitable  and  degrading.  Without  actual 
intellectual  derangement,  he  presents  a  singular  deadness  of  the 
moral  sentiments  and  the  coldest  inertness  of  will ;  family  and 
social  feelings  seem  to  be  extinguished;  there  is  no  sensibility 
to  altruistic  stimuli,  and  no  reaction  therefore  in  answerinsj 
feeling  and  will.  Perhaps  it  may  be  looked  upon  as  an  instance 
of  fitting  retribution  that  the  completest  destruction  of  the 
moral  sense  should  have  its  cause  in  the  vicious  abuse  of  that 
instinct  in  w^hich  it  had  its  original  root. 

With  the  mental  degradation  there  go  in  many  cases,  but  not 
always,  an  averted  eye,  a  dull  expression,  a  sallow  complexion, 
cold  and  clammy  hands,  and  a  languid  circulation.  As  I  have 
already  said,  a  neurotic  temperament  is  a  powerful,  if  not  an 
essential,  co-operant  in  the  production  of  the  effect.  The  worst 
effects  of  the  vice  are  not  so  much  to  be  feared  in  the  openly 
vicious  as  in  youths  who,  having  been  brought  up  strictly  at 
home,  have  not  been  exposed  to  other  temptations,  and  who 
perhaps  to  all  appearances  have  been  most  moral  and  exemplary 
in  their  conduct;  insomuch  that  an  indignant  parent  protests 
against  the  bare  suggestion  of  such  immorality,  forgetting  mean- 
while in  his  haste  that  the  sexual  instinct  has  no  need  of  in- 
struction in  order  to  manifest  and  gratify  itself,  and  that  the 
inclination  to  unnatural  indulgence  is  not  likely  to  be  more 
urgent  where  there  are  frequent  occasions  of  natural  indulgence. 
On  the  other  hand,  schools  are  sometimes  centres  of  infection. 

Let  it  be  noted  with  resjard  to  these  disaoreeable  cases  of 
insanity  that  the  symptoms  differ  somewhat  according  as  the 
mental  breakdown  takes  place  very  soon  after  puberty,  that  is 


454  PATHOLOGY  OF  MIND.  [chap. 

to  say,  before  tlie  sexual  life  has  really  entered  into  tlie  mental 
life  and  there  has  been  time  for  the  character  to  exhibit  its 
influence,  or  according  as  it  takes  place  at  a  later  period,  when 
the  ideas  and  feelings  bear  witness  to  the  sexual  evolution  in 
mind,  and  the  revolution  of  character  has  been  carried  through. 
In  the  former  case  we  have  degenerate  beings  who,  as  regards 
moral  character,  are  very  much  what  eunuchs  are  said  to  be — 
namely,  selfish,  cunning,  deceitful,  liars,  destitute  of  moral 
sentiment,  and  who  furthermore  exhibit  marked  impairment  of 
intellectual  and  bodily  vigour ;  in  the  latter  case  there  is  not  so 
marked  and  exclusive  a  moral  perversion,  but  the  mental  de- 
rangement betrays  more  plainly  the  degradation  of  the  sexual 
instinct.  I  propose  to  describe  in  greater  detail  these  two  classes 
of  cases,  in  order  to  present  a  complete  picture  of  the  course  of 
this  variety  of  mental  degeneracy. 

Medical  advice  is  sometimes  sought  concerning  youths  of 
eighteen  or  nineteen  years  of  age  who  are  causing  no  little 
anxiety  to  their  parents.  The  story  told  is  of  this  kind :  they 
are  not  doing  any  good  at  the  work  to  which  they  have  been 
put,  whether  it  be  at  school  or  in  some  business,  and  their 
masters  complain  that  they  can  make  nothing  of  them.  It  is 
not  that  they  cannot  do  the  work,  if  they  really  try,  for  they 
may  have  done  it  very  well  for  a  time,  and  can  do  it  still  when 
they  are  in  the  mood,  but  for  the  most  part  they  are  moody, 
careless,  absent,  forgetful,  indolent,  and  apathetic,  showing  no 
interest  and  putting  no  energy  in  their  task,  wasting  a  great 
deal  of  time  in  doing  badly  very  simple  things,  perhaps 
muttering  or  laughing  to  themselves,  or  doing  silly  acts  in  a 
way  which  makes  everybody  think  that  they  do  them  wilfully 
while  really  knowing  better.  Their  behaviour  has  all  the  look 
of  bad  disposition  and  wilful  laziness,  and  at  the  outset  is  sure 
to  be  regarded  in  that  light,  but  after  persuasion,  remonstrance, 
and  severity  have  been  tried  in  vain,  and  after  the  work  or  the 
master  has  been  changed — perhaps  more  than  once — the  con- 
viction is  gradually  brought  home  to  those  who  have  to  do  wuth 
them  that  they  cannot  be  right  in  their  minds.  In  their  families 
they  are  selfish,  exacting,  deceitful,  vain  beyond  measure,  capri- 
cious, and  passionate ;  entirely  wanting  in  natural  affection  for 


IX.]  CLINICAL  GROUPS  OF  MENTAL  DISEASE.  455 

their  parents,  and  in  common  consideration  for  others ;  and 
their  pretensions  and  conceit  are  outrageous.  They  do  not 
acknowledge  that  they  are  at  all  in  fault,  but  make  some  excuse, 
no  matter  how  poor,  for  their  conduct  by  putting  the  blame  of 
it  upon  others,  whom  they  allege  to  be  jealous  of  them  or  hostile 
to  them,  or  to  have  injured  their  character  by  what  they  have 
said  of  them;  or  they  persistently  deny  that  they  have  done 
anything  to  warrant  the  least  complaint  against  them ;  or  they 
declare  that  the  work  to  "which  they  have  been  put  is  unworthy 
of  their  position  and  attainments,  although  they  may  have  been 
put  to  it  because  they  failed  in  higher  work  and  the  result  is 
exactly  the  same  whatever  occupation  be  tried.  They  are  much 
disposed  to  solitary  ways,  wandering  about  listlessly  alone,  or 
spending  a  great  deal  of  time  in  their  bedrooms,  if  permitted. 
Tlie  manner  is  usually  downcast  and  suspicious,  and  it  is  not 
easy  for  them  to  look  any  one  straight  in  the  face ;  the  dress  may 
be  untidy  and  slovenly,  or  foppish  and  expressive  of  the  priggish 
conceit  of  their  characters;  the  pupils  are  sometimes  dilated, 
the  hands  often  cold  and  clammy,  the  complexion  is  perhaps 
sallow,  the  breath  bad,  and  the  body  rather  thin. 

Questioned  about  their  vicious  habits,  they  seldom  confess 
them,  and  perhaps  pretend  not  to  understand  w^hat  is  meant. 
Some  of  them  are  too  chaste  for  belief,  for  they  will  deny  ever 
having  had  nocturnal  emissions  ;  others  admit,  when  pressed 
hard,  that  they  fell  into  the  practice  of  self-abuse  when  they 
were  at  school,  but  w^ill  affirm  positively  that  they  have  not 
continued  it.  Seldom  can  faith  be  put  in  their  most  positive 
asseverations  touching  that  matter,  or  in  their  most  solemn 
promises  to  relinquish  the  vice  when  they  confess  to  it.  If  it 
be  not  checked,  they  get  w^orse ;  the  general  suspicion  of  tlie 
ill-feeling  or  hostility  of  persons  to  them  takes  special  forms, 
and  they  come  to  think  that  their  relations  or  others  attempt  to 
poison  them  or  otherwise  injure  them,  that  they  are  maliciously 
worked  upon  by  galvanism  or  electricity,  or  that  persons  make 
offensive  remarks  or  call  out  obscene  or  abusive  words  after 
them  as  they  pass  in  the  streets.^ 

1  The  extract  which  follows,  from  a  letter  by  a  father  concernino"  a  son, 
gives  a  fair  notion  of  the  early  symptoms  :  "  The  case  is  this  :  the  boy, 


456  PATHOLOGY  OF  MIND.  [chap. 

When  the  mental  failure  caused  by  self-abuse  takes  place  at 
a  later  period,  that  is  to  say,  after  the  sexual  life  has  entered 
into  the  circle  of  the  ideas  and  feelings  and  transformed  them, 
the  character  of  the  symptoms  evidences  the  transformation 
which  has  taken  place.  The  patient  is  extremely  shy  of  the 
society  of  women,  and  silent  and  constrained  when  in  their 
company,  but  is  apt  to  fall  in  love,  or  to  think  he  does,  with 
some  woman  wdth  whom  he  may  chance  to  be  brought  into 
occasional  intercourse.  If  he  becomes  engaged  to  her,  which  is 
not  the  case  often,  since  his  so-called  attachment  is  in  the  main 
a  piece  of  self-flattery  by  which  he  strives  to  persuade  himself 
that  he  is  like  other  men,  his  unpleasantly  close  attentions 
betray  a  want  of  manliness  of  feeling  and  a  nasty  lewdness  of 
ideas :  in  fact,  his  behaviour  evinces  a  morbid  sexual  feeling,  in 
the  excitement  of  which  he  finds  pleasure  and  to  the  subsequent 
solitary  gratification  of  which  he  probably  yields,  and  a  lack  of 
restraint  or  manliness  which  most  likely  means  a  real  sexual 
impotence.  Apprehensive  of  such  impotence,  or  alarmed  at  the 
consequences  of  his  vice,  or  otherwise  troubled  about  his  health, 
he  consults  medical  men,  whom  he  usually  asks  whether  they 
would  advise  him  to  marry,  and  always  wearies  with  stories  of 
his  dubitations  respecting  what  he  should  do,  and  regrets  about 
what  he  has  not  done,  and  with  endless  repetitions  of  his  multi- 
tudinous vacillations ;  not  in  the  least  resolved  when  the  matter 
has  been  well  considered  and  apparently  settled  at  last.  He  is 
fond  of  talking  about  getting  married  without  having  the  serious 
intention  of  doing  more  than  talk,  and  if  he  has  got  actually 
engaged  he  is  likely  enough  to  break  off  the  engagement  on 


born  in  1857,  left  school  about  three  years  ago,  and  he  has  been  in  my 
office  and  warehouse  ever  since,  off  and  on.  I  have  reluctantly  come  to 
the  conclusion  that  his  intellect  is  weak,  perliaps  from  bodily  weakness. 
He  does  not  appear  to  be  able  to  apply  himself  to  business,  is  of  a  rather 
romantic  turn  of  mind,  fond  of  writing  poetry,  writes  a  diary,  very 
egotistical,  thinks  himself  far  superior  in  mind  to  his  brothers  and  sisters, 
has  a  long-continued  habit  of  picking-  and  gnawing  his  fingers,  continually 
looks  in  the  looking-glass,  admires  his  face  and  figure,  very  gentlemanly  if 
he  chooses,  verj"-  restless  at  his  meals,  good  appetite,  but  bolts  his  food, 
rubs  his  face  and  hair  with  his  hands,  restless  at  night,  sometimes  crying, 
often  laughs  or  rather  grins  at  nothing,  fond  of  the  theatre,  and,  I  sup- 
pose, thinks  he  could  perform  on  the  stage." 


IX.]  CLINICAL  GIIOUPS  OF  MENTAL  DISEASE.  457 

some  pretext  or  anotlier.  Perhaps  he  withstands  successfully 
for  a  time  his  vicious  propensity,  after  the  perils  of  indulgence 
have  been  pointed  out  forcibly  to  him,  but  before  long  he  falls 
back  into  evil,  and  is  afterwards  depressed,  gloomy,  troubled 
with  all  sorts  of  anomalous  sensations,  and  full  of  fancies  and 
fears  about  his  health.  Does  he  get  so  ftir  as  to  be  engaged,  it 
is  when  the  wedding-day  is  to  be  fixed,  or  is  fixed,  that  his 
doubts  and  agitations  reach  their  height ;  he  is  anxious,  full  of 
hesitations  and  apprehensions  respecting  his  fitness  to  marry^ 
and  puzzles  and  troubles  his  betrothed  or  his  friends  with  his 
vacillations,  his  fears  of  incompatibiHty,  and  the  like ;  in  the 
end  he  probably  breaks  off  the  engagement,  or  runs  away  from 
marriage  at  the  last  moment,  on  some  pretext  of  overstrained 
religious  scruple,  or  because  he  is  overwhelmed  with  the  thought 
of  the  serious  responsibility  of  bringing  children  into  the  world. 
Perhaps  he  discovers  that  the  consummatiun  of  marriage  is  the 
degradation  of  love,  and  will  none  of  it.  Very  remarkable  is  it 
what  a  strain  of  exalted  sentiment  and  lofty  idealism  is  pro- 
fessed in  some  of  these  cases :  the  world  is  too  coarsely  selfish 
and  rudely  practical  for  their  fine  sensibilities  and  nice  aspira- 
tions, and  notwithstanding  that  they  are  sunk  in  a  degrading 
self-indulgence,  and  perhaps  emasculated  by  it,  they  will  pour 
out  loftily  pitched  moral  sentiments,  and  take  it  hotly  to  task  in 
high  conceited  fashion  for  its  low  aims  and  gross  ways.  They 
may  project  some  great  mission  of  social  reform  without  true 
practical  resolve,  as  they  have  abundant  self-conceit  without 
self-knowdedge,  a  spasmodic  sort  of  self-will  without  true  will, 
a  thin  intellectual  eagerness  without  breadth  and  calmness  of 
understanding,  a  morbid  intensity  of  self-feeling  which  they 
mistake  for  altruistic  feeling.  It  is  a  mistake  w^hich  many 
medical  men  make  to  recommend  marriage  to  these  persons  in 
the  hope  of  curing  them,  for  seldom  does  anything  but  sorrow 
and  misery  come  of  it.  Marriage  is  by  no  means  a  certain 
cure  ;  the  confirmed  sinner  has  little  desire  or  power  of  natural 
intercourse,  finding  no  pleasure  in  it;  the  indulgence  of  a 
depraved  appetite  has  destroyed  the  natural  appetite.  Cold- 
ness and  indifference  to  his  wife,  discord,  quarrels  and  threats 
of  violence,  separation  from  bed  or  house,  suicide,  and  even 


458  PATHOLOGY  OF  MIND.  [chap. 

madness  are  more  probable  results  of  such  a  marriage  than 
domestic  peace  and  liappiness. 

Up  to  this  point  one  can  hardly  pronounce  these  persons  to 
be  actually  insane,  although  they  are  far  on  the  road  to  insanity. 
Some  of  them  remain  for  several  years  in  the  state  described 
— perhaps  for  the  rest  of  their  lives — without  getting  worse,  im- 
proving even  as  age  increases  and  passion  wanes.  When  matters 
go  on  from  bad  to  worse  and  actual  derangement  cannot  be  dis- 
puted, this  is  the  state  of  things :  the  feelings  and  conduct  are 
more  deranged  than  the  understanding ;  they  exhibit  an  intense 
conceit  of  self  in  a  quiet  or  in  a  priggish  and  offensive  way ; 
large  discourse  concerning  their  superior  feelings  and  aims  which 
other  people  are  too  gross-minded  to  appreciate ;  paralysis  of 
moral  feeling  with,  at  the  same  time,  excited  enunciation  of 
exalted  sentiments  that  are  the  expression  of  their  assumed 
superiority  in  noble   feelings    and    aspirations ;    a  disorder   of 
intelligence  not  manifest  in  actual  incoherence,  save  when  they 
are  in  a  passion,  but   in  outrageously  exaggerated  notions  of 
their  own  dignity  and  importance,  and  ultimately  perhaps  in 
positive  delusions  of  persecution  by  reason  of  the  envy  and 
jealousy  of  their  relations  and  others  who  are  inferior  to  them. 
The  patient  has   the  insolent  conceit  to  write  to  his  mother 
perhaps  as    "  madam,"  to  declare  that  his  brothers  shall  bow 
down  to  and  honour  him,  and  to  lecture  his  father,  whom  he 
considers  to  be  much  his  inferior  in  intellect  and  moral  feelino-, 
on  the  lowness  of  his  aims  and  the  insufficient  respect  which 
he  shows  him.     Some  of  these  patients  betray  by  their  gait,  by 
a  turlvcy-like  strut,  the  vanity  with  which  they  are  inflated  • 
others  shuffle  about   in  an  indolent  and  apathetic  way,  with 
slouching  gait  and  slovenly  look,  and  head  bent  towards  the 
ground :  the  former  evince,  so  to  speak,  the  convulsion  of  con- 
ceit, the  latter  the  paralysis  of  self-respect.     When  they  are 
challenged  with  their  vicious  practices,  or  are  rebuked  for  some 
impropriety  of  conduct,  or  hurt  in  their  pride  in  any  other  way, 
they  may,  if  not  dead  to  any  touch  of  feeling,  explode  in  stormy 
outbursts  of  offended  dignity  and  angry  abuse,  intermingling  a 
great  deal  of  religious  rant  with  their  abusive  and  incoherent 
raving.     Hallucinations  are  common :  they  hear  voices  which 


IX.]  CLINICAL  GROUPS  OF  MENTAL  DISEASE.  459 

interfere  with  their  thoughts,  reply  to  or  comment  upon  them, 
continually  say  ridiculous,  abusive,  or  obscene  tilings,  and  per- 
haps make  offensive  accusations  against  them  ;  they  see  insults 
in  innocent  gestures,  and  imagine  that  people  make  grimaces 
at  them  in  the  streets ;  they  have  strange  morbid  bodily  feelings 
Avhich,  caused  really  by  their  enervating  vice,  they  ascribe  to 
mesmeric,  electric,  or  other  mysterious  agency ;  and  some  of 
them  fall  from  time  to  time  into  a  sort  of  trance  or  ecstasy,  a 
quasi-cataleptic  state  in  which  they  see  visions  that  are  perhaps 
of  a  religious  character.  Homicidal  and  suicidal  impulses  are 
not  at  all  uncommon,  and  are  the  cause  of  much  mental  distress  ; 
for  the}^  arise  in  the  patient's  mind  against  his  will,  and  although 
he  is  quite  aware  of  their  nature,  he  is  terrified  by  them  and 
fearful  that  he  may  some  day  succumb  to  them.  It  is  seldom, 
liowever,  that  patients  of  this  class  do  yield  to  such  impulses  ; 
they  are  for  the  most  part  too  fearful  of  pain  to  hurt  themselves, 
and  too  wantino;  in  resolution  to  hurt  others. 

When,  degeneration  going  on,  they  reach  the  last  and  w^orst 
stage  of  degradation,  they  sink  into  an  apathetic  state  of  moody 
and  morose  self-absorption  w^ith  extreme  loss  of  mental  power. 
They  sit  or  lie  all  day,  or  saunter  lazily  about,  muttering  or 
smiling  to  themselves,  lost  to  all  healthy  feeling  and  human 
interests,  slovenly  and  dirty ;  if  they  enter  into  any  conversa- 
tion, they  probably  reveal  delusions  of  a  suspicious  or  obscene 
nature.  They  believe  that  they  are  subjected  to  strange  in- 
fluences wdiich  sap  their  vigour,  especially  during  the  night,  and 
perhaps  declare  that  persons  get  into  their  rooms  while  they  are 
asleep,  and  indecently  assault  them  or  perpetrate  unnatural 
offences  upon  them;  their  perverted  sexual  passion  still  gives 
the  colour  to  their  thoughts.  So  they  linger  on,  pitiable  wrecks 
of  degradation,  from  year  to  year,  becoming  w^eaker  in  mind 
and  body,  until  they  die  from  complete  nervous  prostration  or 
from  some  intercurrent  disease  to  which  they  fall  easy  victims 
at  last. 

Such  is  the  natural  history  of  the  physical  and  mental  de- 
generacy which  is  produced  in  men  of  a  certain  neurotic 
temperament  by  solitary  vice.  Certainly  it  is  a  sad  picture 
which  I  have  painted,  but  the  colours  are  not  exaggerated.     Let 


460  PATHOLOGY  OF  MIND.  [chap 

it  be  noted  once  more  that  there  must  be  the  temperament  as 
well  as  the  vice  in  order  to  have  this  characteristic  degeneracy 
produced.  In  another  sort  of  temperament  the  vice  is  the 
exciting  cause  of  an  attack  of  ordinary  acute  mania  or  melan- 
cholia, and  it  is  certainly  sometimes  practised  for  a  long  time 
without  any  mental  ill  effects.  It  must  be  confessed  that  there 
is  little  to  be  done  for  persons  whose  minds  have  once  become 
seriously  affected.  If  they  can  be  constrained  by  any  means  to 
relinquish  the  vicious  habit  at  the  beginning  of  their  troubles 
there  is  good  hope  for  them  ;  but  if  not,  they  will  not  eschew  it  at 
a  later  period,  for  with  the  decay  of  mind  they  have  less  and  less 
desire  and  power  to  overcome  an  ever-present  temptation  which 
has  become  stronger  through  habitual  indulgence.  Again  and 
again  I  have  known  the  best  considered  means,  moral  and 
mechanical,  which  anxious  ingenuity  could  devise  and  the  most 
patient  care  apply,  to  be  brought  to  bear  upon  cases  of  this  kind 
in  order  to  rescue  them  from  themselves,  but  seldom  with  a 
success  that  was  worth  the  pains.  Were  it  legitimate  in  any 
case  to  entertain  or  express  the  feeling  that  the  sooner  a  de- 
graded being  becomes  the  nothing  that  he  was  the  better  for 
himself  and  for  the  world  which  is  well  rid  of  him,  it  would  be 
so  here.  But  the  worst  wrecks  of  humanity  have  these  uses  at 
any  rate — that  they  teach  a  scientific  lesson  by  their  study,  and 
nurture  humane  feeling  by  the  care  which  they  exact. 

It  is  not  certain  that  the  vice  in  women  produces  a  form  of 
mental  disorder  so  characteristically  featured  as  in  men,  or  that 
it  is  so  injurious  to  them.  But  I  cannot  doubt  the  existence 
of  a  variety  of  mental  disease  in  them,  having  some  special 
features,  which  owes  much  of  its  origin  to  sexual  causes  and  is 
usually  accompanied  by  this  vice.  A  young  lady  begins  to  lose 
her  interest  in  her  accustomed  occupations  and  amusements, 
which  she  abandons ;  is  depressed  and  weeps  at  times  without 
apparent  cause,  and  is  uncertain  and  capricious  in  her  beha- 
viour ;  complains  of  strange  and  distressing  bodily  sensations ; 
ceases  to  exhibit  affection  or  consideration  for  her  parents  and 
others  near  and  dear  to  her,  whom  she  afflicts  by  her  perverse 
moods,  her  capricious  temper,  and  her  self-will;  perhaps  she 
forsakes  their  society  in  order  to  spend  a  great  deal  of  time  in 


IX.]  CLINICAL  GROUPS  OF  MENTAL  DISEASE.  461 

her  bedroom,  where  she  occupies  herself  for  long  periods  with- 
out weariness  in  doing  nothing  or  in  doing  very  trifling  things  ; 
or  she  pertly  insists  upon  pursuing  an  independent  course  of 
action  which  is  not  befitting  her  sex  and  position.     The  state 
of  matters  is  oftentimes  worse  during  the  menstrual  periods. 
Nothing   more   than   this   painful   change   of  disposition   and 
caprice  of  conduct  may  be  noticed  at  the  outset,  but  in  the  end 
morbid  fancies  of  some  kind  are  evinced :  she  imagines  perhaps 
that  her  hands  are  soiled  whenever  she  touches  anything,  and 
must  be  continually  washing  them,  or  has  a  tormenting  fear 
that  her  clothes  are  infected  with  insects  and  must  be  all  day 
inspecting  and  brushing  them;  she  gets  some  peculiar  w^ord  or 
ridiculous  thought  into  her  mind  and  is  distressed  because  she 
cannot  get  rid   of  it,  and  fancies  that   it   has  some  indecent 
hidden  meaning ;  she  declares  that  she  cannot  do  some  very 
simple  thing,  and  that  she  suffers  agonies  in  consequence  of 
her  inability ;  she  believes  that  some  gentleman  whom  she  has 
met,  but  who  has  hardly  even  spoken  to  her,  is  in  love  with 
her,  and  has  been  hindered  by  her  friends  or  others  from  pro- 
posing to  her,  and  accordingly  throws  herself  in  his  way  or  even 
writes  him  affectionate  letters.      Perhaps  the  morbid  idea  is 
that  she  is  followed  and  watched  by  persons  w^ho  say  offensive 
things  of  her  and  call  her  improper  names ;  and  that  they  have 
contrived  some  extraordinary  seeing  or  hearing  apparatus  by 
which  they  can  watch  or  listen  to  all  that  goes  on  in  her  room. 
Patients  of  this  class  are  apt  to  make  unfounded  charges  of 
attempts  upon  their  virtue,  and  have  sometimes  written  secretly 
with  diabolical  cunning  a  series  of  letters  containing  the  most 
abominable  accusations  against  innocent  persons.  Sometimes  the 
patient  gets  the  delusion  that  her  soul  is  lost  because  of  her 
wickedness,  and  has  paroxysms  of  weeping  and  seeming  despair  ; 
but  it  is  noticed  that  the  misery  is  not  of  that  deep,  genuine, 
and  continuous  kind  which  usually  accompanies  that  delusion 
it  is  inconstant  and  is  mixed  up  with  a  great  deal  of  hysterical 
caprice  and  wayw^ardness  of  conduct,  which  perhaps  also  dis- 
covers an  erotic  flavour.     In  the  midst  of  what  would  seem  to 
be  the  most  acute  distress,  when  she  is  so  prostrate  with  grief 
as  to  appear  to  notice  nothing  or  is  sobbing  as  if  her  heart  must 


462  PATHOLOGY  OF  illND.  [chap. 

break,  she  will  take  quick  perception  of  the  situation  by  a  sharp 
glance  or  will  look  up  quite  calmly  and  make  a  suitable  answer. 
She  does  no  work,  is  extremely  irritable  and  passionate,  uses 
bad  language,  perhaps  threatens  her  mother,  and  speaks  of 
suicidal  ideas.  Anomalous  sensations  or  actual  pains  in  the 
head,  side,  or  other  parts  of  the  body  are  complained  of,  and  lead 
to  all  sorts  of  strange  doings  for  their  alleviation.  Whilst  her 
daily  conduct  is  such  that  those  who  live  with  her  and  see  her 
from  hour  to  hour  have  not  the  least  doubt  that  she  is  down- 
right insane,  persons  who  see  her  only  for  a  short  time  or  receive 
quite  sensible  letters  from  her  may  not  notice  anything  wrong. 
As  matters  get  w^orse,  there  are  more  paroxysms  of  greater 
excitement,  which  may  be  accompanied  by  much  screaming, 
more  wilful  perversity  of  conduct,  less  and  less  evidence  of 
natural  feelings,  increasing  weakness  of  mind,  and  perhaps  a 
delusion  that  she  has  had  a  baby  or  has  been  accused  of  having 
had  one. 

If  these  patients  are  taken  in  hand  by  suitable  persons  and 
firmly  handled  at  the  beginning  of  their  illness,  they  may  be 
restored  to  health  of  mind.  But  it  is  necessary  to  remove  them 
without  delay  from  among  their  relations,  whom  they  can  affect 
by  their  tears,  distress  by  their  caprices,  frighten  by  their  threats, 
master  by  their  self-will,  to  the  care  of  strangers  w^ho  will  exer- 
cise a  watchful  supervision  and  a  firm  control  over  them,  strive 
with  patient  insistence  to  engage  them  in  work  of  some  kind 
and  in  interests  outside  themselves,  and  systematically  oppose 
to  their  wayward  moods  and  morbid  caprices  the  surroundings 
of  a  healthy  tone  of  thought  and  feeling  and  an  orderly  activity 
of  life.  If  they  are  placed  where  they  perceive  that  their  pecu- 
liarities stir  no  commotion  and  are  not  permitted  to  disturb  the 
quiet  order  of  the  household,  and  where  there  is  everything 
about  them  to  arouse  and  foster  healthy  feeling  and  activity,  they 
are  infected  slowly  by  the  surrounding  tone,  and  the  inclination 
to  indulge  their  morbid  feelings  and  whims  decreases  gradually 
until  it  becomes  a  greater  pain  than  pleasure  to  do  so.  If,  how- 
ever, they  are  not  taken  firmly  in  hand,  but,  being  thought  to 
be  only  hysterical,  are  suffered  to  go  on  at  home  from  week  to 
week  and  month  to  month  without  proper  control,  as  commonly 


jx.]  CLINICAL  GROUPS  OF  MENTAL  DISEASE.  463 

liappeiis,  they  slide  by  au  easy  descent  into  incurable  dementia; 
the  real  gravity  and  ominous  import  of  the  symptoms  being  out 
of  all  proportion  to  their  seeming  insignificance.  Were  mind- 
slaughter  an  indictable  offence,  many  a  too  aifectionatc  parent 
would  have  to  stand  his  trial  for  an  unwise  indulgence  of 
feeling  against  the  stifled  convictions  of  judgment. 

Althoudi  I  have  described  this  form  of  mental  derano^ement 
in  women  under  the  head  of  insanity  of  self-abuse,  inasmuch 
as  the  vice  certainly  prevails  in  most  cases,  I  should  be  loth 
to  say  that  a  similar  mental  breakdown  does  not  happen  some- 
times when  there  is  not  sufficient  reason  to  suspect  its  exist- 
ence, as  the  effect  of  a  developing  and  unfulfilled  sexual 
life  upon  a  certain  nervous  temperament  whose  stability  it  over- 
throws. These  cases  in  women  differ  from  the  corresponding 
cases  in  men  in  this — that  while  the  latter  seem  to  care  not  for 
women  and  shyly  avoid  them,  being  satisfied  with  secret  self- 
indulgence,  the  former  evince  often  by  their  feelings  and  conduct 
a  desire  for  men.  But  the  difference  is  not  so  real  as  it  appears 
on  the  surface.  Sinners  of  the  male  sex  shrink  from  female 
society  not  so  much  because  they  actually  dislike  it,  as  from  an 
extreme  shyness  and  self-distrust  ;  they  have  not  the  courage  to 
pay  attentions  to  a  woman  whom  in  their  hearts  they  would  like 
to  address  ;  instinctively  they  feel  themselves  to  be  unmanned ; 
their  vicious  indulgence  has  deprived  them  of  the  source  of 
energy  and  manliness  which  emboldens  the  male  to  a  confident 
address.  On  the  other  hand,  female  sinners  who  show  an  incli- 
nation towards  men  sometimes  exhibit  quite  an  opposite  feeling 
when  they  have  become  engaged  or  have  been  married;  they 
may  break  off  the  engagement  or  display  an  acute  repugnance  i 
to  sexual  intercourse,  which  they  refuse,  or  fall  into  melancholy 
or  mania ;  and  a  marriage  which  was  perhaps  schemed  and 
made  with  infinite  cunning  as  a  means  of  cure  serves  only  to 
make  plain  their  sad  state. 

Hysterical  Insanity. 

Without  doubt  hysterical  symptoms  sometimes  run  on  by 
degrees  into  actual  insanity,  but  considering  how  common  a 
disease  hysteria  is,  it  must  be  confessed  that  this  issue  is  rare. 


464  PATHOLOGY  OF  MIND.  [chap. 

More  often  certain  forms  of  mania,  especially  those  that  occur 
in  connection  with  sexual  development,  present  what  are  called 
, hysterical  features.  Mention  has  already  been  made  of  the 
strange  and  extreme  moral  perversion  shown  by  such  hysterical 
young  women  of  a  nervous  temperament  as  imagine  that  their 
limbs  are  paralysed  and  lie  in  bed  or  on  a  couch  day  after  day, 
pretend  that  they  cannot  speak  at  all  or  can  speak  only  in 
feeble  whispers,  affirm  that  they  never  pass  water  and  that  they 
live  without  food,  exhibit  strange  substances  which  they  protest 
they  have  passed  by  the  bowel  or  otherv/ise,  fabricate  so-called 
stigmata  or  singular  diseases  of  some  kind.  It  seems  probable 
that  their  extremely  perverted  moral  state  has  its  principal  or  an 
actively  co-operating  cause  in  the  effect  of  some  condition  of 
the  reproductive  organs  on  the  brain,  since  it  so  frequently 
occurs  in  young  unmarried  women,  presents  erotic  features,  and 
is  likely  to  be  cured  outright  by  marriage.  What  is  the  actual 
condition  of  things  underlying  the  temperament  which  is 
designated  hysterical,  I  know  not,  nor  shall  I  venture  to  con- 
jecture ;  it  shall  suffice  here  to  direct  and  claim  attention  to  the 
profound  moral  disturbance  which  it  may  undoubtedly  occasion. 
Hysterical  mental  disorder  in  other  instances  is  of  a  much 
more  active  kind,  taking  the  form  of  acute  mania.  Then  we 
shall  notice  great  excitement  and  restlessness  of  somewhat  noisy 
and  tumultuous  kind,  with  laughing  and  constant  chattering ; 
the  patient  perhaps  recognises  those  who  address  her  and  calls 
them  correctly  by  their  names,  but  instantly  runs  off  into 
incoherent  and  voluble  talk ;  if  asked  to  show  her  tongue  she 
thrusts  it  out  and  draws  it  back  rapidly,  hardly  interrupting  her 
turbulent  flow  of  talk,  or  refuses  pertly,  perhaps  bursting  out 
into  wild  laughter,  or  saying  or  doing  something  of  an  indelicate 
character.  In  her  best  moods  she  is  apt  to  be  mischievous — will 
incontinently  kick  the  washhand  basin,  bath  or  other  utensil 
ovei  out  of  a  pure  spirit  of  mischief ;  but  her  laughing  and  good- 
humoured  jabbering  are  likely  to  alternate  with  periods  of 
irritability,  weeping,  and  ill  humour,  and  with  fits  of  screaming 
when  her  humours  are  opposed.  And  opposition  cannot  be 
avoided,  since  she  may  ring  the  bell  continually  if  she  can  get  at 
it,  tear  her  clothes,  expose  herself  indecently,  attempt  to  run  out 


IX.]  CLINICAL  GROUPS  OF  MENTAL  DISEASE.  465 

of  the  house  and  do  similar  illegitimate  things.  Perhaps  she 
will  suddenly  throw  herself  back  on  her  bed  or  on  the  floor  and 
lie  there  motionless  in  a  sort  of  quasi-cataleptic  state  in  which 
she  seems  to  be  insensible  to  impressions ;  or  she  falls  into 
paroxysms  of  violent  shudderings  in  wdiich  all  the  voluntary 
nmscles  are  spasmodically  contracted,  the  contractions,  which 
have  the  air  of  exaggerated  voluntary  action  and  of  having  been 
W' ilfuUy  set  a-going,  being  accompanied  with  consciousness.  The 
habits  are  apt  to  become  unclean.  Sexual  excitement  reveals 
itself  sometimes  in  her  eyes,  in  her  gestures,  in  her  speech,  even 
in  the  odour  of  her  body,  and  she  is  apt  to  speak  of  persons 
being  in  love  with  her,  of  being  married,  of  having  babies  and 
the  like.  Mixed  up  with  the  erotic  features  in  some  cases  is  no 
little  religious  exaltation,  and  the  incoherent  talk  show^s  that 
those  passages  in  the  Bible  which  bear  on  the  secret  relations 
of  the  sexes  have  not  been  overlooked. 

Recovery  takes  place  in  the  greater  number  of  cases  of  this 
form  of  acute  mania  when  it  is  taken  vigorously  in  hand  at  the 
commencement,  and  then  usually  within  three  months  of  its 
outbreak.  The  prognosis  becomes  unfavourable  when  it  subsides 
into  a  subacute  phase  and  goes  on  from  month  to  month  with 
alternating  periods  of  excitement  and  moody  apathetic  depres- 
sion ;  it  is  unfavourable  also  when  the  mania  is  recurrent,  as  it 
is  somewhat  apt  to  become.  When  the  disease  is  going  the 
wrong  way  the  mind  is  gradually  weakened  and  the  decline  is 
into  dementia. 

The  late  Dr.  Skae  proposed  to  class  a  group  of  cases  of  mental 
derangement  under  the  designation  of  Amenorrhceal  Insanity, 
meaning  thereby  to  bring  together  those  in  which  the  suppres- 
sion of  the  menses  w^as  the  immediate  and  essential  cause  of 
the  disease.  He  did  no  more,  how^ever,  than  sketch  vaguely  the 
outlines  of  the  sympjtoms  of  this  proposed  clinical  variety,  and 
I  have  failed  to  perceive  that  his  outlines  are  in  the  least 
characteristic.  Without  doubt  an  outbreak  of  insanity  may 
follow  a  suppression  of  the  menses  and  be  directly  due  to  it, 
disappearing  with  the  return  of  them,  but  I  know^  nothing  in 
the  symptoms  of  the  derangement  so  caused  to  distinguish  it 
from  mania  or  melancholia  otherwise  caused.     The  features,  so 


466  PATHOLOGY  OF  MIND.  [chap. 

far  as  tliey  are  special,  are  determined  by  tlie  temperament  of 
the  individual  and  by  the  state  of  his  mind  and  body  at  the 
time,  rather  than  by  the  exciting  cause  of  the  outbreak.  It  is 
common  enough  for  the  menses  to  be  irregular  or  suppressed  in 
acute  insanity,  the  derangement  of  the  function  being  an  effect, 
or  a  concomitant,  or  one  among  other  co-operating  conditions  of 
the  insanity ;  but  he  must  be  an  acute  observer  who  can  detect 
the  difference  between  the  effect  produced  upon  the  features  of 
the  mental  disease  by  the  suppressed  function  when  it  is  looked 
upon  as  concomitant  rather  than  cause,  accidental  rather  than 
essential,  and  the  effect  produced  by  it  when  it  is  thought  to  be 
the  immediate  and  essential  cause.  Certainly  we  cannot  venture 
to  classify  the  varieties  of  insanity  by  their  supposed  causes. 
The  characteristic  features  of  the  clinical  varieties  which  have 
been  just  described  as  occurring  in  connection  with  sexual  de- 
velopment bear  witness  in  the  main  to  two  predominant  bodily 
states  rather  than  to  a  special  cause  in  each  case — namely,  first, 
to  the  youth  of  the  patient,  whence  the  liveliness,  the  wilful- 
ness, the  laughing  incoherence,  the  tumultuous  energy  when  the 
disease  is  maniacal,  and  the  conceit,  the  ignorant  pretensions, 
i\m\  the  iQoral  perversion  and  caprice  when  it  has  a  melancholic 
form  ;  and,  secondly,  to  the  irruption  and  activity  of  the  sexual 
system,  whence  the  erotic  features. 

Puerperal  Insanity, 

This  might  be  described  as  prepuerperal  and  post-puer- 
peral. A  woman  sometimes  falls  insane  during  pregnancy,  and 
although  it  is  probable  that  she  who  does  so  has  inherited  a 
strong  predisposition  to  the  derangement,  one  naturally  looks 
upon  the  bodily  condition  as  the  exciting  cause.  Proof  of  the 
remarkable  effects  which  pregnancy  can  exert  upon  the  mind 
is  afforded  by  the  strange  cravings  and  longings  for  particular 
articles  of  food  and  by  the  morbid  fears  which  pregnant  women 
not  unfrequently  display  during  its  earlier  months.  On  the  other 
hand,  I  have  met  with  three  instances  in  which  women  who  were 
melancholic  when  not  pregnant  became  cheerful  and  apparently 
weU  when  they  fell  into  that  condition.     The  form  which  the 


IX.]  CLINICAL  GROUPS  OF  MENTAL  DISEASE.  4G7 

mental  derangement  of  pregnancy  most  often  takes  is  melan- 
cholia, and  those  women  are  most  likely  to  suffer  from  it  who 
liave  married  late  in  life,  and  whose  system,  having  lost  much 
of  its  suppleness,  is  less  able  to  accommodate  itself  to  the  new 
conditions.  Its  features  do  not  differ  specially  from  those  of 
melancholia  otherwise  caused :  there  are  often  vague  apprehen- 
sions and  fears,  despairs  and  suicidal  feelings.  Eecovery  takes 
place  in  the  greater  proportion  of  cases  ;  some,  however,  decline 
into  dementia  ;  and  in  a  few  cases  the  morbid  depression,  having 
continued  up  to  parturition,  has  been  then  followed  by  an  out- 
break of  acute  insanity,  commonly  acute  mania.  One  cannot 
justly  look  forward  to  that  event  with  the  sanguine  hopes  that 
are  commonly  entertained  in  such  case;  a  gradual  recovery 
during  pregnancy  is  worth  more  than  the  most  confident  anti- 
cipations of  a  sudden  recovery  at  its  termination. 

Puerperal  insanity  is  the  name  properly  given  to  that  form  of 
mental  disorder  which  comes  on  within  a  month  or  two  after 
childbirth.  When  it  comes  on  within  a  fortnight  of  delivery 
the  symptoms  are  usually  maniacal ;  when  after  the  lapse  of  a 
fortnight  they  are  most  often  melancholic.  The  mania  is  of  an 
acute,  turbulent,  and  incoherent  kind;  the  patient  being  noisy, 
restless,  sleepless,  and  evincing  very  little  method  in  what  she 
does,  and  very  little  coherence  in  what  she  says ;  she  snatches 
at  anything  near  her,  tosses  the  bedclothes  off,  starts  up  and  will 
not  remain  in  bed,  catches  up  in  a  quick  but  utterly  meaning- 
less way  a  word  or  two  of  what  is  said  to  her  or  in  her  hearing, 
w^hirling  it  into  the  chaotic  turmoil  of  her  speech,  and  not  un- 
frequently  exhibits  some  lasciviousness  of  thought  and  behaviour. 
Hallucinations  of  vision  are  betrayed  by  the  way  in  which  she 
stares  at  imaginary  objects  or  speaks  to  imaginary  persons,  and 
by  the  gross  mistakes  which  she  makes  respecting  the  identities 
of  persons  about  her,  whom  she  calls  by  wrong  names  and 
perhaps  addresses  in  familiar  or  even  endearing  terms,  although 
they  are  strangers  to  her.  The  bodily  symptoms  accord  not 
usually  with  the  violence  of  the  mental  disorder,  the  pulse 
being  often  quick,  small,  and  irritable,  the  face  pale,  drawn,  and 
pinched,  and  the  general  condition  feeble.  Suicide  may  be  done 
in  a  purposeless    way;   it  is  then  rather   an  incident  in  the 


4G8  PATHOLOGY  OF  MIND.  [chap. 

unreasoning  fury  of  her  behaviour  than  a  designed  or  even  clearly 
conscious  act.  If  her  child,  incautiously  left  in  her  charge,  falls 
a  victim  to  her  frenzy,  the  homicide  is  an  act  of  much  the  same 
character.  One  lady  whom  I  saw  was  not  aware,  after  her  re- 
covery from  an  attack  of  acute  puerperal  mania,  that  she  had 
borne  a  child ;  and  another  lady  could  not  be  persuaded,  when 
she  had  recovered,  that  the  child  which  she  had  had  was  hers, 
and  although  she  suffered  it  to  be  brought  up  with  her  other 
children,  and  afterwards  bore  a  child  which  she  made  not  the 
least  doubt  to  be  hers,  she  held  to  her  opinion  with  respect  to 
it  and  never  showed  it  a  mother's  affection. 

Puerperal  mania  furnishes  a  large  percentage  of  recoveries, 
generally  within  from  three  to  six  months  from  the  outbreak 
of  the  malady  ;  where  it  lasts  some  months  longer  the  outlook 
is  unfavourable.  As  the  excitement  subsides  it  sometimes 
leaves  behind  a  good  deal  of  confusion  and  apparent  feebleness 
of  mmd — a  hazy,  dreamlike,  or  demented-looking  state — from 
which  the  patient  awakens  by  degrees  to  restored  reason.  Com- 
plete recovery  coincides  oftentimes  with  the  normal  return  of 
the  menstrual  function. 

I  have  nothing  special  to  say  concerning  the  features  of  the 
melancholia  that  occurs  soon  after  parturition.  The  depression, 
which  begins  with  dislike  or  suspicion  of  husband,  nurse,  and 
those  about  her,  is  generally  accompanied  with  suicidal  impulse, 
and  in  not  a  few  cases  there  starts  up  out  of  the  morbid  gloom 
a  strong  impulse  to  kill  her  child — an  impulse  which,  notwith- 
standing the  horror  which  it  causes  her  in  the  first  instance,  is 
not  unlikely  to  be  carried  into  effect  if  the  child  be  not  taken 
from  her  care.  Nor  is  there  anything  special  to  be  said  of  the 
melancholia  which,  occurring  at  a  later  period  after  parturition, 
has  been  described  as  the  Insanity  of  Lactation.  It  is  preceded 
by  symptoms  of  cerebral  exhaustion  and  general  prostration — 
headache,  ringing  in  the  ears,  dimness  of  vision,  flashes  of  light 
before  the  eyes,  and  a  general  feeling  of  weariness  and  debility; 
and  it  appears  mostly  to  be  due  to  the  bodily  exhaustion  pro- 
duced by  suckling,  in  conjunction  often  with  depressing  moral 
influences.  In  most  cases  there  is  good  reason  to  anticipate 
a  timely  recovery  if  suitable  measures  be  taken  to  restore  the 


IX.]  CLINICAL  GROUPS  OF  MENTAL  DISEASE.  469 

bodily  strength  by  putting  a  stop  to  the  debilitating  drain  and 
by  giving  good  nourishment,  and  to  revive  the  mental  tone  by 
removing  the  patient  from  depressing  influences  and  giving  her 
the  benefit  of  rest  of  brain  and  change  of  scene. 


Climacteric  InscLnity. 

This  is  the  name  given  to  the  mental  disorder  which  befalls 
in  women  at  the  so-called  chanw  of  life.  During  this  crisis  of 
their  lives  they  commonly  suffer  more  or  less  from  various  ano- 
malous feelings  of  bodily  distress,  and  from  some  depression  or 
discomfort  of  mind — symptoms  that  bear  witness  to  the  disturb- 
ance of  the  circulation  and  of  the  nerve  functions ;  and  some  of 
them  go  through  much  suffering  before  their  constitutions  are 
adjusted  to  the  new  conditions  of  life.  It  is  the  time  too  when 
the  age  of  pleasing  is  past,  the  desire  of  man.  being  no  longer 
to  them  ;  wherefore  if  the  life  has  been  one  of  empty  vanity  and 
habitual  self-indulgence,  and  the  wish  to  be  an  object  of  desire 
and  flattering  attention  remains,  the  unwelcome  proof  of  their 
decline  is  a  trial  which  they  do  not  bear  welL  Thus  mental  and 
bodily  causes  may  work  together  to  produce  a  morbid  depression 
of  mind.  An  insane  jealousy,  having  its  root  in  the  apprehen- 
sion of  the  extinction  of  the  power  to  provoke  desire,  sometimes 
shows  itself  in  an  extremely  exacting  form,  in  unfounded  suspi- 
cions of  a  husband,  in  gross  accusations  of  unchastity,  in  much 
violence  of  passion  and  conduct ;  and  a  habitually  indulged  pro- 
pensity to  alcoholic  stimulants,  which  may  have  been  taken  in 
the  first  instance  to  relieve  the  feelings  of  mental  depression 
and  bodily  sinking,  makes  more  frantic  the  paroxysms  of  jealous 
fury.  This  sort  of  insane  jealousy  is  certainly  not  special  to  the 
climacteric  period ;  it  may  be  met  wdth  before  that  change  in 
women  who  have  livM  the  sort  of  life  of  self-indulgence  to 
evoke  and  foster  it ;  but  it  is  most  likely  to  break  out  or  to  be 
greatly  exaggerated  then.  The  gratification  of  a  selfish  passion 
is  like  the  gratification  of  a  liking  for  stimulants ;  the  appetite 
grows  by  what  it  feeds  on,  and  the  doses  necessary  to  produce 
the  pleasing  effects  must  be  progressively  increased,  until  in 
the  end  such  a  state  of  moral  and  physical   deterioration   is 


470  PATHOLOGY  OF  MIND.  [chap. 

produced  that  the  largest  doses  only  avail  to  palliate  a  distress 
which  is  declared  to  be  unendurable  without  them. 

When  the  mental  disturbance  incident  to  the  climacteric 
change  goes  on  to  unquestionable  insanity — and  there  is  almost 
always  a  hereditary  predisposition  when  it  does — the  disease 
has  the  melancholic  form.  In  many  cases  a  vast  and  over- 
whelming apprehension  of  some  great  but  undefined  impending 
calamity  is  exhibited  in  a  terror-stricken  countenance,  in  con- 
stant agitation  of  behaviour,  in  frequent  ejaculations  of  distress ; 
the  patient  is  sure  that  something  dreadful  is  going  to  happen, 
but  cannot  in  the  least  explain  what  it  is  she  fears.  Or  there 
may  be  such  vague  delusions  as  that  the  whole  world  is  in 
flames  or  is  turned  upside  down,  that  everything  in  it  is  changed, 
neither  person  nor  thing  remaining  the  same,  that  her  memory 
and  other  faculties  are  gone,  that  her  soul  is  doomed  to  ever- 
lasting torment  in  hell.  She  is  many  times  curiously  conscious 
of  her  state,  so  much  so  that  while  holding  firmly  to  her  de- 
lusions she  perhaps  admits  herself  to  be  a  proper  subject  of 
medical  care,  and  declares  that  she  ought  to  be  sent  to  an 
asylum  in  order  to  prevent  her  from  doing  harm  to  herself  or 
to  others,  at  the  same  time  that  she  expresses  a  great  horror  of 
such  a  procedure,  and  protests  that  it  will  drive  her  out  of  her 
mind  entirely  and  that  she  never  can  be  restored  to  her  former 
state  of  comfort  whatever  be  done.  "It  is  all  in  vain;  you 
don't  believe  what  I  tell  you ;  but  I  know  something  unspeak- 
ably dreadful  will  happen  to  me — oh  dear,  oh  dear ! "  is  the 
wearisome  burden  of  her  exclamations.  Suicidal  feelings  are 
sometimes  very  strong,  and  persistent  refusal  of  food  may 
necessitate  forcible  feeding.  As  many  as  half  of  these  cases 
may  be  expected  to  get  well  if  properly  treated,  but  not  always 
quickly ;  the  disease  is  apt  to  last  for  a  considerable  time  in 
some  of  them  before  recovery  takes  place. 

Some  authors  suppose  that  there  is  a  critical  period  in  men  be- 
tween fifty  and  sixty  years  of  age,  corresponding  to  the  climacteric 
change  in  women,  and  that  they  also  suffer  sometimes  from  a 
climacteric  insanity.  It  is  certain  that  there  is  no  such  abrupt 
and  marked  physiological  change  in  men  as  is  natural  to  women, 
but  it  is  not  improbable  that  a  similar  constitutional  change  takes 


IX  ]  CLINICAL  GROUPS  OF  iMENTAL  DISEASE.  471 

place  in  a  more  gradual  way  and  is  spread  over  a  longer  period. 
When  a  man  has  made  self-gratification  the  sole  or  main  interest 
of  his  life,  and  in  pursuit  thereof  has  indulged  the  sexual  passion 
to  excess,  and  when  he  finds  his  interests  gone  by  the  extinction 
of  desire,  he  is  without  aim  or  pleasure  in  his  self-indulgent 
life,  and  may  well  fall,  if  he  is  of  a  decided  nervous  tempera- 
ment and  has  a  predisposition  to  mental  disease,  into  a  morbid 
melancholy.  In  such  event  the  melancholy  is  sometimes  of  an 
extremely  hypochondriacal  nature :  he  complains  of  anomalous 
pains  in  all  parts  of  the  body  which  he  describes  as  causing  him 
the  greatest  agony ;  of  the  absence  of  all  appetite  for  food, 
although  he  eats  very  well ;  of  habitual  sleeplessness,  which 
others  do  not  observe ;  of  inability  to  exert  himself  to  take 
exercise,  and  of  the  frightful  suffering  which  he  endures  after- 
wards if  he  forces  himself  to  do  so,  notwithstandiDg  that  he  may 
plainly  enjoy  the  exercise  at  the  time,  always  however  without 
admitting  that  he  does  so ;  he  protests  that  he  cannot  remember, 
cannot  read,  cannot  employ  his  mind  in  any  way,  although  his 
faculties  show  themselves  as  acute  as  ever  they  were  when  he 
can  be  lured  to  exercise  them,  or  when  he  exercises  them 
on  his  own  account,  as  he  does  more  frequently  than  he  pre- 
tends ;  and  he  is  continually  uttering  his  fears  that  he  will 
go  out  of  his  mind,  and  begging  to  be  told  candidly  whether 
he  will  or  not.  "\A^iatever  be  the  subject  of  conversation 
started  he  brings  it  round  to  himself,  and  is  never  wearied 
of  relating  the  story  of  his  torturing  sensations  and  assuring 
his  listener  what  agony  he  endures  every  moment  of  his  life. 
Call  his  attention  to  an  ache  or  a  pain  which  he  has  not,  and 
next  day  he  will  have  it.  Although  he  may  be  gifted  with 
a  mind  of  superior  powers  in  some  respects,  and  is  clearly 
conscious  of  his  state  and  earnestly  anxious  to  be  delivered 
from  it,  he  cannot  get  out  of  himself  and  interest  himself  in 
anything  but  his  sufferings :  his  morbid  self  is  the  one  thing 
alone  which  he  cares  to  talk  about.  "VATien,  after  the  long  detail 
of  them,  he  has  received  all  the  encouragement  and  assurance 
that  can  be  given  him,  he  begins  again  telling  the  same  story 
and  asking  the  same  questions,  just  as  if  nothing  had  been 
said.     His  afflictions  are  assuredly  genuine,  however  much  they 

21 


472  PATHOLOGY  OF  IMIND.  [<  hap. 

may  have  the  air  of  being  magnified  and  systematically  nursed ; 
they  are  so  unceasing  that  he  oftentimes  thinks  and  speaks 
of  suicide,  and  so  insupportable  sometimes  that  he  makes  a 
desperate  attempt  at  suicide  in  one  of  his  paroxysms  of  distress. 
I  knew  one  gentleman  suffering  in  this  way  who  on  one  occa- 
sion threw  himself  over  the  bannisters  of  the  stairs  from  the 
second  floor  of  his  house  into  the  hall,  injuring  himself  seriously, 
and  on  another  occasion  thrust  into  his  abdomen  a  knife  which 
he  had  concealed.     Both  attempts  were  unsuccessful. 

I  do  not  wish  to  describe  this  sort  of  extreme  hypochon- 
driacal melancholia  as  exclusively  climacteric,  since  it  may 
certainly  occur  at  an  earlier  period  of  life,  especially  where 
sexual  pleasure  and  power  have  been  exhausted  prematurely 
by  excesses,  but  it  is  perhaps  most  often  met  with  in  con- 
nection with  that  constitutional  change.  I  am  apt  to  think 
that  in  many  cases  of  the  kind  there  is  a  commencing  de- 
generation of  the  coats  of  the  arteries,  of  an  atheromatous 
nature,  whereby  the  proper  nutrition  of  the  brain  is  hindered, 
and  that  this  degeneration  is  a  more  potent  cause  of  the  mental 
depression  than  the  sexual  change.  As  the  sufferer  pours  out 
his  tale  of  woe,  one  notices  perhaps  a  twisted  artery  with  rigid 
coats  winding  over  one  or  the  other  of  his  temples,  and  feels  that 
if  that  outward  and  visible  sign  of  decay  of  structure  is  a  mark 
of  the  state  of  the  small  arteries  within  the  brain,  there  is 
little  hope  that  he  will  be  delivered  from  the  gloom  which  en- 
velopes him.  However,  the  arterial  degeneration  is  certainly 
not  observed  in  all  cases. 

Senile  Insanity. 

It  is  in  this  form  of  insanity  that  we  are  most  likely  to  find 
atheromatous  cerebral  arteries,  which,  if  they  are  not  directly 
the  cause,  are  at  any  rate  the  mark,  of  a  real  decay  of  brain. 
Miliary  aneurisms,  which  have  been  described  in  at  least  one 
case,  are  strong  proof  of  arterial  degeneration.  Shrunken  con- 
volutions, and  serous  effusion  under  the  arachnoid  to  fill  up 
the  void  made  by  the  decay  and  absorption  of  nerve-elements, 
result  from,  and  i3ear  witness  to,  the  defective  nutrition.     With 


IX.]  CLINICAL  GUOUPS  OF  MENTAL  DISEASE.  473 

tlie  decay  of  brain  goes  a  corresponding  decay  of  mind,  the 
symptoms  of  which  are  characteristic.  They  may  be  described 
as  the  exaggeration  of  the  natural  decline  of  mental  faculties 
which  often  accompanies  the  bodily  decline  of  old  age. 

The  symptom  which  attracts  first  and  most  notice  is  an  impair- 
ment of  memory,  particularly  in  respect  of  recent  events  ;  these 
are  perceived  correctly  at  the  time,  but  are  not  retained;  although 
they  may  have  appeared  to  arouse  proper  interest  when  they 
happened,  they  are  clean  gone  from  the  mind  in  a  day  or  two, 
or  in  an  hour  or  two,  or  in  extreme  cases  the  moment  after- 
wards, while  long-past  incidents  are  talked  of  as  if  they  were 
affairs  of  yesterday.  The  memory  is  long-sighted,  so  to  speak, 
seeing  not  what  is  close  at  hand,  but  seeing  fairly  w^ell  what  is 
distant.  This  persistence  of  past  memories  with  the  loss  of 
rccent  ones  is  the  cause  of  a  striking  want  of  congruity  between 
the  habitual  thoughts  and  the  actual  circumstances  of  daily 
life,  and  gives  to  the  patient's  conduct  an  air  of  greater  imbecility 
than  it  actually  warrants.  If  his  attention  be  actively  roused  by 
some  stimulus  and  the  facts  be  put  quietly  and  clearly  before  him 
he  may  apprehend  them  correctly  and  even  pass  a  sound  judg- 
ment upon  them,  notwithstanding  that  he  may  not,  if  questioned 
a  few  days  or  some  hours  afterwards,  be  able  to  give  a  good  account 
of  what  he  said  or  did,  and  may  incontinently  babble  of  some- 
thing which  took  place  twenty  years  before.  The  next  step  in 
the  course  of  his  brain-decay  is  an  impairment  of  the  power  of 
perception,  in  consequence  of  which  he  fails  to  apprehend  cor- 
rectly what  occurs  and  to  recognise  familiar  persons  and  places : 
he  mistakes  trains  of  ideas  belonging  to  the  past  for  present 
perceptions,  talks  as  if  he  were  now  in  a  place  where  he  has 
not  been  for  years,  and  supposes  a  person  whom  he  sees  for  the 
first  time  to  be  some  one  whom  he  knew  years  ago.  JSTot  recog- 
nising one  whom  he  had  formerly  known  quite  well,  he  will 
inquire  of  him  after  his  own  health  as  if  he  were  making  the 
inquiry  of  another  person ;  he  will  express  his  surprise  that 
somebody  who  has  been  dead  for  a  long  time  does  not  come  to 
see  him  ;  will  ask  the  same  question  over  and  over  again  within 
a  few  minutes,  forgetting  instantly  on  each  occasion  that  it  has 
been  asked  and  answered.     There  are  considerable  variations  in 


474  PATHOLOGY  OF  MIND.  [chap. 

his  mental  capacity  at  different  times  according  to  variations  in 
his  bodily  health  ;  he  may  remember  an  incident  one  day  which 
he  had  clean  forgotten  the  day  before,  or  mistake  the  identity 
of  a  person  to-day  whom  he  will  perhaps  recognise  to-morrow. 

As  decay  proceeds  it  effaces  more  and  more  the  lines  of 
mental  function  ;  memory  and  perception  are  nearly  extinct  ; 
the  patient  knows  not  those  who  are  constantly  about  him,  and 
forgets  instantly  whatever  happens.  His  brain  can  neither 
receive  nor  register  impressions.  Its  past  registrations,  which 
persist  after  recent  ones  have  been  effaced,  are  disorganised,  so 
that  he  jumbles  together  persons  and  events  in  the  most  con- 
fused way,  his  talk  is  fragmentary  and  incoherent  rambling,  and 
his  conduct  has  no  relation  to  his  external  conditions.  He  gets 
up  in  the  middle  of  the  night,  insisting  that  it  is  day,  or  goes 
to  bed  at  midday  believing  that  it  is  night ;  imagines  that  he  is 
occupied  in  work  which  he  has  not  touched  for  many  years,  or 
wonders  why  he  is  not  so  occupied,  and  blames  angrily  those 
whom  he  supposes  to  be  hindering  him  from  setting  to  work ; 
seems  perhaps  to  understand  a  very  simple  question  when  it  is 
slowly  and  plainly  put  to  him,  so  as  to  give  time  for  the  sound 
of  each  word  to  reach  his  apprehension,  and  begins  a  reply 
which,  his  attention  breaking  down  after  the  first  word  or  so, 
becomes  utterly  confused  and  meaningless ;  or  he  cannot  compre- 
hend in  the  least  what  is  said  to  him,  and  says  something  that 
is  altogether  irrelevant  and  incoherent.  In  many  cases  there 
are  morbid  suspicions  or  actual  delusions  that  he  is  being 
robbed  or  maltreated,  or  that  some  great  injury  is  to  be  done  to 
him,  and  the  paroxysms  of  noisy  excitement  which  occur  in 
consequence  are  a  great  trouble  to  those  who  have  the  care  of 
him.  His  social  feelings  are  involved  with  his  intelligence  in 
the  common  "  ruin  of  oblivion  ;  "  all  the  feeling  which  he  shows 
being  anger  at  the  supposed  injuries  done  him,  or  an  outburst 
of  the  tears  of  dotage  from  time  to  time.  Oftentimes  his  habits 
are  uncleanly.  At  last  he  dies,  the  machinery  of  his  organism 
completely  worn  out. 

It  is  interesting  to  compare  these  symptoms  of  mental  decay 
with  the  symptoms  of  failing  mind  that  are  natural  to  the 
decline  of  old  age.   Then  the  sharpness  of  the  senses  is  blunted. 


IX.]  CLINICAL  GROUPS  OF  MENTAL  DISEASE.  475 

especially  those  of  siglit  and  hearing,  and  when  the  old  person 
appears  to  hear  what  is  said  it  sometimes  takes  an  appreciable 
interval  of  time  before  the  sensation  of  sound  reaches  the 
chamber  of  apprehension.  Kesponsive  vibrations  are  less  easily 
excited  and  more  slowly  conducted.  The  energy  and  suppleness 
of  mind  and  body  are  likewise  lessened ;  he  is  more  circumspect 
and  cautious,  more  dull  in  apprehension,  more  slow  in  ideas,  more 
measured  in  his  language  and  in  his  movements ;  his  memory 
fails  him  and  his  judgment  is  impaired,  being  slow  and  hesitat- 
ing. Hence  there  is  an  appearance  of  greater  prudence  and 
wisdom  than  are  really  possessed,  since  people  are  apt  to  mistake 
the  slowness  of  judgment  and  gravity  of  manner  for  sagacious 
deliberation.  However  good  in  counsel,  the  old  man  is  bad  in 
execution  where  decision  and  vigour  are  required.  His  interest 
in  current  events  wanes,  he  cannot  assimilate  new  experience, 
which  therefore  makes  only  a  fleeting  impression  upon  him,  and 
he  shrinks  from  new  enterprises ;  being  truly  in  a  state  of 
gradual  dissolution,  it  is  natural  that  he  does  not  take  an  active 
part  in  a  process  of  evolution  ;  he  lauds  the  past,  concerning 
wdiich  he  has  the  memories  of  interest  and  policies  and  achieve- 
ments, finds  no  such  giants  living  nowadays  as  when  he  was  in 
his  prime,  and  wonders  what  the  world  is  coming  to  with  its 
revolutionary  changes.  Moreover  there  is  the  beginning  of  that 
decline  of  the  moral  faculties  which  reaches  extinction  in  senile 
dementia  ;  peevishness  and  quarrelsomeness,  avarice,  excessive 
vanity,  obstinate  self-opinion,  dictatorial  self-will,  loss  of  moral 
enthusiasm  and  moral  courage,  cynicism  and  misanthropy  are 
modes  in  which  the  moral  decline  shows  itself.  When  one  con- 
templates the  daily  suffering  which  the  old  man  lagging  super- 
fluous on  the  stage  inflicts  sometimes  upon  those  who  are  under 
his  sway  and  forecasts  the  amount  of  good  which  his  obstructive 
self-opinion  prevents  being  done,  it  needs  a  moment's  reflection 
to  check  the  upspringing  regret  that  his  disappearance  from  the 
scene  must  be  left  to  the  slow  operation  of  natural  decay.  How 
often  does  the  vain  and  suspicious  victim  of  senility  take  up  an 
unreasoning  prejudice  or  dislike,  rising  perhaps  to  an  insane 
animosity,  against  some  honest  relative  or  former  friend,  or 
an  excessive  and   not  less   unreasoning   liking,  amounting  to 


476  rATHOLOGY  OF  iMlND.  [chap. 

infjituation,  for  some  adventurer,  relative  or  not,  who  flatters  his 
foibles !  Here  then  we  have  the  initial  stages  of  the  lines  of 
mental  degeneracy  which  end  in  the  phenomena  of  senile  de- 
mentia— failure  of  memory  ending  in  its  extinction;  dulncss 
of  apprehension  ending  in  loss  of  power  of  perception ;  wane  of 
interest  in  what  is  going  on  ending  in  incapacity  to  appreciate 
the  surroundings ;  slowness  of  ideas  and  hesitation  of  judgment 
ending  in  incoherence  and  fatuity;  decay  of  moral  feeling  ending 
in  drivelling  suspicions  and  tears  of  dotage. 

Although  senile  dementia  usually  comes  on  by  a  gradual 
decay,  as  I  have  described  it,  in  some  cases  it  is  ushered  in 
by  a  period  of  mental  excitement  which  gives  the  patient  a 
transient  and  fictitious  appearance  of  energy  and  capacity. 
He  shows  great  mental  exaltation  and  self-confidence,  transacts 
business  in  a  sanguine  and  reckless  way  that  is  quite  the  oppo- 
site of  his  ordinary  sober  and  prudent  ways,  broaches  projects 
or  launches  into  speculations  of  a  transparently  foolish  character 
which  he  cannot  be  persuaded  are  not  excellent,  indulges  freely 
in  alcohol,  associates  with  low  company,  and  visits  or  goes  about 
openly  with  women  of  loose  character,  although  hitherto  a  grave 
and  reverend  senior;  impatient  of  advice  or  opposition,  he 
repudiates  social  ties  and  resents  all  attempts  at  interference  or 
control,  is  irritated  and  angry  with  his  family  who  try  to  check 
his  follies,  and  occasions  them  no  little  perplexity  and  distress 
by  his  doings.  When  the  excitement  expires,  as  it  sometimes 
does  suddenly,  he  falls  into  a  state  of  dementia. 

There  is  another  form  of  senile  insanity  which  I  have  ob- 
served particularly  in  old  women,  and  which  I  take  leave  to 
describe  as  senile  melancholia.  They  are  acutely  depressed  and 
show  extreme  distress  at  whatever  is  proposed,  wander  tip  and 
down  their  room  or  the  house  in  restless  agitation,  cannot  be 
persuaded  that  they  are  not  ruined  and  soon  to  be  turned 
destitute  into  the  streets,  or  that  some  other  dreadful  calamity  is 
not  impending  over  them  and  their  relations,  repeat  the  same 
exclamations  of  grief,  or  keep  up  a  continual  moauing,  varied 
only  by  wild  shrieks  or  yells  of  acuter  anguish.  Frequently 
they  refuse  food  frantically,  thinking  it  to  be  drugged  or 
poisoned,  or  declaring  it  to  be  filth  or  carrion^  or  even  the  flesh 


IX.]  CLINICAL  GROUPS  OF  iMENTAL  DISEASE.  477 

of  their  relations,  or  protesting  that  they  cannot  swallow  it. 
They  are  remarkably  quick  in  perception  and  exact  in  memory, 
notwithstanding  their  delirium,  being  much  more  conscious  of 
what  is  going  on  about  them  than  they  seem  to  be ;  are  extremely 
suspicious,  passionate,  and  wilful  withal,  striking,  scratching,  or 
pinching  their  attendants,  whose  needful  services  they  resist ; 
use  perhaps  such  bad  language  as  it  is  a  surprise  they  should 
ever  have  known — language  which  is  sometimes  very  obscene, 
and  accompanied  with  indecent,  dirty,  or  grossly  immodest  acts. 
"What  one  notices  specially  in  these  cases  is  the  extraordinary 
moral  perversion  that  is  mixed  up  with  the  depression,  giving 
the  appearance  of  extreme  Avilfulness  to  their  behaviour,  the 
gross  extravagance  of  the  horrid  ideas  which  come  into  their 
minds  and  force  themselves  out  into  their  speech — surprising 
themselves  suddenly  perhaps  in  the  first  instance  and  causing 
them  to  shriek  out  in  a  panic  of  distress — the  sexual  excitement 
manifest  in  the  ideas  and  acts,  and  withal  the  singular  clearness 
of  their  understanding  when  the  mind  can  be  lifted  for  a 
moment  out  of  its  morbid  groove.  In  some  the  excitement 
rises  to  such  a  height  that  they  do  not  sleep,  cannot  be  got  to 
take  necessary  nourishment,  and  die  at  last  from  exhaustion ;  in 
others  it  subsides,  and  the  disease  continues  in  a  more  clnonic 
form.     In  no  case  is  the  forecast  favourable. 

This  concludes  what  I  have  to  say  concerning  the  features  of 
the  varieties  of  mental  disorder  that  occur  in  connection  with 
processes  of  bodily  development  and  of  bodily  decline — Evolu- 
tional and  Dissolutional  forms  of  derangement,  as  any  one  may 
call  them  who  thinks  to  throw  light  upon  obscure  phenomena 
by  giving  them  big  but  undefined  names  w^ritten  with  initial 
capital  letters. 

Phthisical  Insanity. 

Under  this  name  Dr.  Clouston  has  proposed  to  group  a  class 
of  cases  in  which  insanity  and  phthisis  make  their  appearance 
nearly  at  the  same  time  in  the  patient,  and  the  features  of  the 
former  malady  are  somewhat  modified  in  consequence.  I  ques- 
tion, however,  whether  the  peculiar  neurotic  temperament  which 
is  so  often  met  with  in  phthisical  persons  has  not  much  more  to 


478  PATHOLOGY  OF  MIND.  [niAP. 

do  with  tlie  features  of  the  mental  malady  than  any  deposit  of 
tubercle,  especially  as  it  is  acknowledged  that  phthisical  insanity^ 
so  called,  may  befall  in  persons  of  the  phthisical  diathesis  who 
have  no  symptoms  of  local  tubercular  deposit. 

Without  doubt  many  phthisical  persons  exhibit  features  of 
character  in  some  respects  peculiar.     They  are  quick,  irritable, 
fanciful,   and   changeable,   eager   in   project   and   impatient  of 
opposing  delays,  very  idealistic,  but  unstable  of  purpose,  bril- 
liant in   flashes,  but  wanting  in  breadth  and   calm   depth  of 
thought,  and  in  methodical  and  steady  perseverance ;  quick  in 
insight  and  intense  in  energy,  they  see  the  project  of  the  hour 
and  press  for  its  realisation  as  the  one  important  thing  in  the 
world,  and  in  a  short  time  perhaps  are  engaged  with  as  eager 
interest  and  abandonment  in  some  other  project ;  there  is  some- 
thing fitful  in  their  projects,  in  their  energy,  in  their  moods,  in 
their  displays  of  imagination — a  sort  of  hectic  in  their  thoughts, 
feelings,  and  actions.     As  the  end  of  life's  fitful  fever  is  neared, 
the  whims  and  wanderings  of  the  mind  merge  into  a  transitory 
delirium,  and  the  fancies  become  almost  delusions.   Very  notable 
too  is  the  singular  hopefulness  which  is  shown  in  the  disease 
even  to  the  last,  notwithstanding  that  the  continuity  of  the 
sanguine   feeling   is  often  interrupted  by  passing  intervals  of 
despondency;    day  after  day  the  patient  speaks  hopefully  of 
himself  as  better,  although  he  presents  plainly  every  token  of 
the  steady  progress  of  his   disease,  and  when  within  the  very 
shadow  of  death  may  discuss  a  change  of  life,  and  project  what 
he  will  do  in  years  that  will  never  come  to  him. 

The  insanity  which  occurs  in  connection  with  phthisis  cannot 
be  said  to  have  very  distinctive  symptoms.  It  may  have  the 
form  of  mania,  of  melancholia,  or  of  monomania,  and  it  is  the 
general  course  of  the  disease  rather  than  any  special  feature  of 
it  which  has  attracted  notice.  The  acute  stage,  when  there  is 
one,  whether  it  be  maniacal  or  melancholic,  is  of  very  short 
duration,  and  does  not  run  on  into  the  ordinary  chronic  malady, 
nor  into  distinct  dementia,  but  lapses  quietly  into  an  irritable, 
excitable,  moody,  and  suspicious  state  without  any  fixed  delusion, 
which  is  a  sort  of  mixture  of  subacute  mania  and  dementia. 
The  suspiciousness  is  thought  to  be  the  feature  which  is  most 


IX.]  CLINICAL  GROUPS  OF  MENTAL  DISEASE.  479 

constant,  and  the  most  characteristic  Ly  itself;  indeed  Dr. 
Clouston  believes  that  nearly  all  cases  of  pure  monomania  of 
suspicion  will  be  found  to  be  phthisical.  When  there  is  no 
acute  sta^e  at  the  befdnninir,  the  derancjement  comes  on  in  an 
insidious  way,  showing  itself  by  irritability,  waywardness,  and 
caprice,  Avith  progressive  weakening  of  intellect,  but  without 
any  marked  excitement  or  depression.  Later  on  the  increasing 
irritability  may  pass  into  brief  attacks  of  excitement  with  im- 
pulsive acts  that  have  a  demented  character,  and  later  still  the 
symptoms  of  dementia  increase.  But  the  appearance  and  con- 
duct of  these  patients  are  calculated  to  suggest  the  notion  of  a 
greater  dementia  than  actually  exists ;  they  will  make  from 
time  to  time  fitful  displays  of  intelligence  of  which  they  might 
well  be  thought  incapable,  and  in  them  there  happens  more 
often  than  in  other  patients  a  momentary  revival  of  intelligence 
before  death.  The  oncoming  of  insanity  seldom  benefits  the 
phthisis :  in  a  few  cases  certainly  it  is  followed  by  the  arrest  of 
the  phthisis  and  the  disappearance  of  its  symptoms  ;  in  more 
cases  the  mania  and  the  phthisis  seem  to  take  turn  and  turn 
about,  the  one  being  active  while  the  other  is  in  comparative 
abeyance ;  but  in  most  cases  the  phthisical  symptoms  are  only 
masked  by  the  mental  symptoms,  the  disease  going  steadily  on 
the  while.  The  prognosis  is  bad  in  phthisical  insanity ;  in  the 
few  instances  in  which  recovery  takes  place  it  is  where  there  is 
no  actual  deposit  of  tubercle,  or  where  the  deposit  has  only  just 
taken  place. 

It  is  beyond  doubt  that  we  do  meet  with  cases  of  mental 
derangement  presenting  the  features  just  described  as  phthisical, 
but  1  should  be  loath  to  affirm  on  the  one  hand  that  we  do  not 
meet  with  similar  mental  features  where  there  is  no  suspicion  of 
phthisis  and  no  known  predisposition  to  it,  and  on  the  other 
hand  that  they  will  be  met  with  in  all  cases  of  insanity  com- 
plicated with  phthisis.  It  is  probable  that  we  have  to  do 
essentially  with  a  peculiar  neurotic  temperament,  which  under- 
goes actual  derangement  in  partial  consequence  of  the  enfeebled 
nutrition  of  tuberculosis,  and  I  doubt  not  that  if  we  had  the 
same  temperament  acted  upon  by  some  other  cause  of  de- 
teriorated nutrition  to  produce  mental  derangement  it  would 


480  PATHOLOGY  OF  MIND.  [chap. 

present  the  same  features ;  indeed  we  get  something  very  like 
them  sometimes  in  the  insanity  of  the  thin  artistic  temperament, 
and  in  the  insanity  caused  by  self-abuse  in  conjunction  with  a 
certain  neurotic  temperament.  Still  if  the  features  described 
are  most  often  observed  in  connection  with  phthisis,  it  will  be 
convenient  to  gather  the  cases  into  a  separate  clinical  group 
provisionally,  and  to  call  them  by  a  name  which  marks  their 
most  constantly  observed  relation. 


Bypliilitic  Insanity. 

It  is  customary  nowadays  to  speak  of  a  group  of  cases  by  this 
name,  the  practical  justification  of  the  custom  being  that  their 
pathology,  their  causation,  and  their  proper  treatment  are  at  once 
indicated  thereby.  If  what  cures  the  syphilis  will  cure  the 
insanity  it  would  be  a  pedantic  conceit  to  reject  so  useful  a 
grouping  simply  because  it  was  not  scientific  enough.  Let  it 
be  admitted  that  there  is  no  symptom  which  is  characteristic  of 
this  sort  of  insanity,  and  will  enable  us  to  distinguish  it  on  all 
occasions,  as  it  must  in  candour  be,  it  may  still  be  maintained 
that  when  we  look  to  the  entire  course  of  the  disease,  observing 
how  the  symptoms  begin,  their  character,  how  they  are  asso- 
ciated with  and  succeed  one  another,  and  how  they  end,  there  is 
good  reason  to  warrant  an  empirical  grouping  of  the  cases,  apart 
from  the  help  in  diagnosis  which  we  get  from  the  history  and 
from  the  old  signs  of  syphilis. 

The  order  of  events  in  a  case  of  syphilitic  insanity  I  conceive 
to  be  of  this  kind :  the  patient  has  suffered  from  constitutional 
syphilis,  and  is  much  distressed  by  deep-seated  headaches,  which 
are  increased  by  movement  and  are  worse  at  night ;  the  scalp  is 
perhaps  tender  when  pressed,  and  the  headache  even  increased 
thereby.  He  is  deeply  dejected,  destitute  of  energy,  incapable 
of  undertaking  his  work,  in  a  state  of  great  alarm  about  himself, 
and  extremely  sensitive  to  noises  and  to  sudden  impressions  of 
any  kind.  The  nights  bring  no  refreshing  rest,  but  rather  an 
aggravation  of  his  sufferings ;  he  is  sleepless,  not  from  pain  in 
the  head  only,  but  even  when  he  has  not  pain  enough  to  prevent 
sleep  3  or  if  he  does  sleep,  it  is  in  short  snatches  from  which  he 


IX.]  CLINICAL  GROUPS  OF  MENTAL  DISEASS.  481 

awakes  sometimes  in  a  state  of  trembling  alarm,  hardly  knowing 
whether  he  has  slept,  or  even  where  or  what  he  is,  so  that  he 
almost  dreads  to  fall  into  such  unconsciousness  again.  There  is 
the  greatest  prostration  without  fever ;  loss  of  appetite,  with 
vomiting  sometimes  but  without  gastric  disorder,  is  marked  ;  rapid 
emaciation  takes  place,  and  the  pulse  is  irregular  and  often  slow. 
The  eyes  should  now  be  examined  by  the  opthalmoscope  in 
order  to  see  whether  there  be  optic  neuritis ;  if  there  is,  then 
the  presence  of  a  syphilitic  product  in  the  brain  is  very  prob- 
able ;  it  is  practically  certain,  according  to  Dr.  H.  Jackson,  if 
the  neuritis  existed  before  the  illness  became  acute.  Next  some 
signs  of  sensory  or  motor  disorder  are  likely  to  show  themselves 
— to  wdt,  paralysis  of  sensation  or  of  motion  in  eyelid,  muscles 
of  eye,  face,  or  other  part  of  the  body — since  the  paralysis  may 
implicate  a  single  nerve,  or  be  hemiplegic,  or  be  more  or  less 
completely  general — blindness,  giddiness,  and  difficulty  of  mus- 
cular co-ordination,  spasms,  and  even  epileptiform  convulsions 
eventually.  Up  to  this  point  we  may  consider  the  disease  to  be 
in  its  first  stage,  and  the  sufferer  may  recover  after  a  time  with- 
out any  further  bad  symptoms.  But  if  he  gets  worse  he  begins 
to  lose  his  memory,  and  the  other  faculties  of  his  mind  undergo 
serious  impairment;  there  is  an  increasing  stupidity,  which 
passes  soon  into  deep  dementia.  Outbursts  of  mania  and  of 
melancholia  interrupt  the  steady  mental  decline  in  some  in- 
stances, and  it  is  not  very  uncommon  for  it  to  be  accompanied 
by  symptoms  of  progressive  muscular  paralysis  so  like  those  of 
general  paralysis  of  the  insane  that  the  one  disease  may  easily 
be  mistaken  for  the  other.  The  mistake  is  particularly  likely  to 
be  made  when  besides  the  mental  weakness  there  are  delusions 
of  grandeur,  as  is  sometimes  the  case.  Epileptiform  and  apo- 
plectiform attacks  usually  occur  in  the  later  stages,  and  there  is 
little  hope  of  recovery  when  they  do;  there  is  barely  a  hope 
w^arranted  when  the  patient  has  become  profoundly  demented. 
Still  the  exceptional  occurrence  of  a  quick  and  an  unlooked-for 
recovery  now  and  then  in  what  seemed  the  worst  condition  of 
things  may  preclude  absolute  despair.  The  syphilitic  product 
[gumma)  in  the  brain  to  which  the  symptoms  are  due  is  more 
likely  to  be  absorbed  than  a  tumour  of  another  kind. 


482  PATHOLOGY  OF  ]\IIND.  [chap. 

We  have  no  reason  to  suppose  that  the  syphilitic  gumma  acts 
differently  from  what  any  other  tumour  or  morbid  deposit  in  its 
position,  and  increasing  at  the  same  rate,  would  do,  and  every 
reason  to  suppose  that  the  symptoms  which  it  causes,  so  far  as 
they  are  special,  are  characteristic  of  cerebral  tumour,  not  of 
syphilitic  tumour  in  particular.  It  probably  either  acts  as  a 
centre  of  irritation,  exciting  the  neighbouring  parts  of  the  brain 
to  morbid  activity — delirium  and  convulsions ;  or  it  encroaches 
steadily  upon  them,  occasioning  destruction  of  function — de- 
mentia, coma,  and  paralysis ;  or  it  appears  sometimes  to  produce 
a  thickening  of  the  coats  of  the  small  cerebral  arteries,  by  the 
deposit  of  plasma  in  them,  and  so  to  lead  to  the  production  of 
thrombosis,  which  will  then  act  just  as  thrombosis  in  the  same 
position  but  otherwise  caused  would  do.  In  considering  the 
pathological  meaning  of  the  symptoms  it  must  of  course  be 
borne  in  mind  that  a  destruction  of  a  part  of  the  brain  may  not 
only  cause  directly  the  positive  symptoms  due  to  loss  of  its 
function,  but  may  be  the  indirect  cause  of  abnormal  activity  in 
another  part  by  withdrawing  the  controlling  or  inhibiting  in- 
fluence which  one  member  of  the  intimate  physiological  union 
exercises  upon  another. 

The  diagnosis  will  rest  mainly  upon  a  previous  history  of 
syphilitic  symptoms,  and  upon  the  marks  they  may  have  left 
behind  them;  upon  the  occurrence  of  the  disease  at  an  age  when 
a  similar  nervous  derangement  from  other  causes  is  unusual; 
upon  the  absence  of  any  other  discoverable  cause  of  disease ; 
upon  the  irregular  character  and  the  disorderly  association  and 
sequence  of  the  various  symptoms,  mental  and  bodily ;  and  upon 
the  successful  results  of  specific  treatment.  Albeit  then  the 
syphilitic  deposit  produces  no  specific  nervous-  symptoms,  there 
is  usually  something  in  the  general  course  of  syphilitic  insanity 
which  is  not  quite  what  is  observed  in  the  cases  of  other  cerebral 
tumours,  and  is  calculated  to  raise  a  suspicion  of  its  nature. 

In  one  who  has  suffered  from  a  previous  attack  of  mental 
derangement,  or  who  has  inherited  a  strong  predisposition  there- 
to, it  has  happened  that  an  outbreak  of  acute  mania  has  taken 
place  at  the  same  time  as  the  secondary  symptoms  of  syphilis 
have  made  their  appearance.    But  there  is  notliing  special  about 


IX.]  CLINICAL  GPiOUPS  OF  MENTAL  DISEASE.  483 

the  mania  in  such  event ;  it  is  merely  that  a  brain  strongly  pre- 
disposed to  derangement  has  been  overthrown  by  a  particular 
constitutional  disturbance,  as  it  might  be  overthrown  by  another 
disturbance.  In  like  manner  when  mania  occurs  after  syphilitic 
epilepsy,  as  it  does  sometimes,  there  is  nothing  special  in  its 
symptoms.  It  has  been  alleged  that  in  such  cases  the  mania' 
most  often  follows  those  epileptic  paroxysms  in  which  loss  of 
consciousness  occurs  not  at  the  commencement  of  the  attack, 
but  as  a  later  event — in  w^hich,  therefore,  the  mischief  pre- 
sumably does  not  begin  in  the  supreme  cerebral  centres. 

AlcoJioHc  Insanity. 

It  is  a  fixed  popular  opinion,  but  a  popular  error,  that  when  a 
person's  mind  gives  way  in  consequence  of  alcoholic  intemperance 
he  must  have  delirium  tremens.  Without  doubt  he  may  have 
delirium  tremens,  but  on  the  other  hand  he  may  have  a  genuine 
acute  mania  that  has  no  character  of  delirium  tremens  about 
it.  Persons  who  have  been  previously  insane,  or  who  have 
suffered  an  injury  to  the  head  which  produced  severe  symptoms 
at  the  time,  or  who  have  had  a  sunstroke,  or  who  have  inherited 
a  strong  predisposition  to  insanity,  or  who  are  epileptic — persons 
in  fact  who  have  a  natural  or  acquired  undue  irritability  and 
instability  of  brain — are  liable  to  have  their  irritable  and 
unstable  brains  upset  by  slight  alcoholic  excesses  and  to  do 
very  strange  and  eccentric  things  in  consequence,  or  even  to 
compromise  themselves  by  some  act  of  impulsive  violence: 
perhaps  they  give  themselves  up  to  the  police  as  the  perpetrators 
of  an  undiscovered  murder  which  has  made  a  great  sensation;  or 
commit  some  indecent  offence  which  brings  them  into  a  police 
court;  or  inflict  serious  injury  upon  some  one  against  whom  they 
have  conceived  an  unfounded  suspicion,  only  realising  the 
gravity  of  w^hat  they  have  done  when  they  come  to  themselves 
after  the  effects  of  the  alcoholic  disturbance  have  passed  off. 
The  little  self-control  which  they  have,  owing  to  inherent  weak- 
ness of  brain,  is  easily  abolished,  the  co-ordination  of  its  func- 
tions overthrown,  and  with  it  that  consciousness  of  personal 
identity   and   responsibility   which   is   its    highest   expression. 


484  PATHOLOGY  OF  iMIND.  [chap. 

After  a  prolonged  alcoholic  debauch  the  mental  derangemont 
may  take  the  form  of  acute  mania — the  true  mania  a  potu  so- 
called — which  is  usually  of  a  noisy  and  destructive  character,  but 
differs  not  in  essential  features  from  mania  due  to  other  causes. 
In  some  instances  the  derangement  is  melancholic,  but  I  am 
inclined  to  think  that  melancJiolia  a  potu,  as  it  might  be  called, 
is  most  likely  to  occur  in  persons  whose  health  has  been  im- 
paired by  long  continued  excesses  and  insufficient  nourishment, 
and  who  are  obliged  to  forego  their  drinking  without  getting 
better  nourishment. 

The  symptoms  of  delirium  tremens  are  tolerably  characteristic, 
and  I  need  only  recount  them  briefly  here.  Premonitory  of  its 
outbreak  are  feelings  of  lowness  of  spirits  and  debility,  nausea 
and  vomiting  in  the  mornings,  loss  of  appetite,  little  sleep,  and 
that  little  disturbed  by  frightful  dreams.  The  person  dreads  to 
face  his  work,  is  anxious  about  his  affairs,  agitated  by  the  least 
unusual  occurrence,  oppressed  by  gloomy  forebodings,  and  is 
described  as  excessively  nervous ;  his  hands  shake  on  occasion 
of  the  least  mental  agitation,  and  his  tongue  is  tremulous  and 
coated  v/ith  a  soft  whitish  fur.  Upon  these  symptoms  follow 
mental  excitement  and  delirium,  the  delirium  being  generally 
characterised  by  great  agitation  and  alarm ;  there  are  hallucina- 
tions and  illusions,  the  patient  seeing  rats  and  mice  running 
about  the  room,  snakes  crawling  over  the  bed,  or  having  terror- 
striking  visions  of  threatening  objects.  His  restlessness  is 
extreme  and  he  gets  no  sleep.  He  talks  almost  incessantly,  but 
says  little  that  is  sensible.  His  hands,  which  are  in  constant 
tremulous  motion,  he  moves  over  the  bed-clothes  as  if  seeking 
for  something,  or  thrusts  out  as  if  to  push  back  the  vermin  that 
he  sees  invading  his  bed.  The  pulse,  which  is  quickened,  is 
small  and  compressible  at  the  wrist,  but  full  and  throbbing  in 
the  carotid  arteries,  the  heart's  action  violent,  and  the  breathing 
panting  and  irregular.  In  general  he  is  manageable,  though 
restless,  but  sometimes  he  is  violent  and  hard  to  be  controlled ; 
and  he  may  even  jump  out  of  the  window,  if  not  prevented,  either 
in  pursuit  of  phantoms  whom  he  imagines  to  threaten  him  or 
in  his  terrified  eff^orts  to  escape  from  them.  After  three  or 
four  days  of  this  delirious  horror  he  falls  into  a  sound  sleep  and 


rx.]  CLINICAL  GROUPS  OF  MENTAL  DISEASE.  485 

recovers,  if  the  issue  be  favourable,  or  sinks  into  a  low  muttering 
delirium  and  dies,  if  the  issue  be  unfavourable.  When  the 
attack  is  over  there  is  great  mental  and  bodily  feebleness  in  all 
cases,  and  in  a  few  cases  the  mind  is  found  to  be  not  quite  clear ; 
it  is  more  or  less  confused,  troubled  with  morbid  suspicions,  and 
perhaps  with  hallucinations  of  hearing,  and  prone  to  suicidal 
impulses.  This  occasional  after-effect  is  most  likely  to  be 
seen  where  there  was  a  predisposition  to  mental  derangement, 
and  most  likely  to  be  got  rid  of  by  abundant  exercise  in  the 
open  air,  entire  change  of  scene,  and  variety  of  occupation  and 
amusement.  If  the  hallucinations  of  hearing  persist  notwith- 
standing these  measures,  doubts  of  complete  mental  restoration 
gather  and  thicken. 

Delirium  tremens  might  be  described  justly  as  an  acute 
alcoholism,  since  there  is  also  a  chronic  alcoholism  which  is 
characterised  by  the  slow  and  gradual  development  of  similar 
symptoms — in  truth,  a  chronic  delirium  tremens  which  is  called 
the  insanity  of  alcoholism.  Premonitory  of  it  are  the  same 
sleeplessness,  the  same  motor  restlessness,  the  same  nausea  and 
want  of  appetite  that  go  before  delirium  tremens.  Instead,  how- 
ever, of  the  rapidly  rising  excitement,  the  changing  hallucina- 
tions and  delirious  incoherence  then  following,  there  is  great 
mental  disquietude  with  morbid  suspicions  or  actual  delusions  of 
wrongs  intended  or  done  against  him,  of  wilful  provocations 
and  persecutions  by  neighbours,  of  thieves  about  his  premises, 
of  unfaithfulness  on  the  part  of  his  wife  and  the  like;  sus- 
picions which  are  frequently  attended  with  such  hallucinations 
of  hearing,  of  sight,  of  tactile  sensation,  as  threatening  voices 
heard,  insulting  gestures  or  mysterious  signs  seen,  electric 
agencies  felt.  In  this  state  a  violent  tempered  man,  resolved  to 
be  even  with  the  scoundrels  whom  he  declares  to  be  persecuting 
him,  sometimes  does  sad  deeds  of  violence.  Recovery  usually 
takes  place  if  the  patient  is  resolutely  prevented  from  getting 
alcohol.  His  hallucinations  disappeai'  first  in  the  daytime, 
being  as  bad  as  ever  perhaps  during  the  night ;  then  they  are 
less  vivid  at  night,  being  most  marked  in  the  stage  between 
sleep  and  waking ;  next  they  are  no  more  than  bad  dreams  or 
nightmares,  and  at  last  they  go   entirely.     The  order  of  their 


486  PATHOLOGY  OF  MIND.  [chap. 

disappearance  is  the  opposite  of  tlieir  order  of  occurrence. 
Unfortunately  the  recovery  seldom  lasts ;  inasmuch  as  the 
patient  goes  back  to  his  indulgence  as  soon  as  he  can,  the 
chances  are  that  he  has  other  attacks,  and  that  in  the  end  his 
mind  is  permanently  impaired.  His  memory  is  so  damaged 
perhaps  at  last  that  it  has  no  more  hold  of  recent  impressions 
than  that  of  one  who  suffers  from  senile  dementia  ;  his  under- 
standing is  enfeebled  and  even  childish ;  his  moral  sense  is 
blunted  or  destroyed,  so  that  he  loses  all  feeling  of  moral 
responsibility,  and  becomes  cunning,  cowardly,  untruthful,  and 
untrustworthy ;  and  his  will  is  so  deteriorated  that  he  has  not 
the  least  control  over  himself  in  respect  of  indulgence  in  drink. 
Muscular  unsteadiness  and  trembling  go  with  these  signs  of 
increasing  mental  debility,  and  there  is  oftentimes  sensory  dul- 
ness  or  actual  sensory  and  motor  paralysis  of  the  limbs ;  on 
which  account  he  cannot  hold  firmly  with  them,  perhaps 
dropping  helplessly  what  he  takes  into  his  hand,  or  lies  in  bed 
because  he  cannot  use  his  legs  to  walk.  At  the  same  time  one 
cannot  help  feeling  sometimes  that  he  could  grasp  better  and 
make  more  use  of  his  legs  if  he  would  exercise  more  will.  In 
some  cases  there  are  epileptiform  convulsions  from  time  to  time — 
perhaps  many  in  succession — which  are  accompanied  with  much 
albumen  in  the  urine.  This  condition  of  mental  impairment 
may  be  brought  about  gradually  by  a  steadily  continued  course 
of  excessive  drinking  in  some  persons,  and  especially  in  women, 
without  any  of  the  hallucinations  and  delusions  of  persecutions 
that  go. before  it  in  other  cases.  At  a  later  and  worse  stage  tlie 
patient  is  completely  demented,  his  mind  being  thoroughly  dis- 
organised ;  he  utters  the  most  incoherent  nonsense  in  a  whining 
tone,  and  has  the  most  extravagant  hallucinations  and  delusions 
— as,  for  example,  that  the  most  extraordinary  scenes  occur  in 
his  room,  that  knives  and  broken  glass  are  coming  out  of  his 
flesh,  that  insects  are  crawling  between  his  flesh  and  skin,  that 
people  cut  up  his  body,  carry  him  away  at  night,  and  the  like. 
The  mental  deterioration  is  so  great  that  he  resembles  not  a 
little  in  mental  symptoms  a  person  who  is  in  the  last  stage  of 
senile  dementia. 

The  insanity  produced  by  alcohol  is  instructive,  for  it  exhibit^ 


IX.]  CLINICAL  GROUPS  OF  MENTAL  DISEASE.  487 

in  more  rapid  sequence  a  train  of  symptoms  very  like  those  of 
ordinary  idiopathic  insanity,  so-called,  and  exhibits  them  in  a 
case  where  we  can  clearly  trace  the  operation  of  a  physical 
cause.  We  know  of  a  certainty  that  the  alcohol  is  absorbed  into 
the  blood,  that  it  is  carried  by  it  to  the  brain,  and  that  it  acts 
there  directly  upon  the  nervous  tissue,  from  which  indeed  it  may 
be  extracted  again  when  it  has  been  taken  in  quantity.  Its  first 
effect  is  to  stimulate  the  tissue  and  cause  increase  of  activity, 
but  in  the  end  it  produces  degeneration  of  tissue  and  destruc- 
tion of  function.  Let  it  be  noted  too  that  it  acts  equally 
perniciously  upon  the  different  nervous  centres,  motor,  vaso- 
motor, sensory,  and  ideational,  the  collective  symptoms  of  this 
impartial  action  giving  its  peculiar  physiognomy  to  alcoholic 
insanity. 

Dipsomania  is  a  well-marked  form  of  mental  degradation,  if 
not  of  actual  mental  derangement,  which  shows  itself  in  a  fierce 
morbid  craving  for  alcoholic  stimulants  and  is  greatly  aggravated 
by  indulgence.  Had  alcohol  never  been  tasted  by  the  individual 
the  desire  would  probably  have  slumbered,  but  once  indulgence 
has  aAvakened  the  desire,  it  flames  quickly  into  an  uncontrollable 
craving.  The  outbreaks  are  commonly  paroxysmal — at  longer 
intervals  of  a  year  or  so,  or  at  shorter  intervals  of  two  or  three 
months,  or  even  more  often  still  in  bad  cases.  The  victim  of 
this  drink-craving  does  not,  like  the  ordinary  drunkard,  get 
drunk  in  company,  and  then  become  sober,  remaining  so  until 
the  next  early  and  convenient  opportunity  of  getting  drunk 
again,  but  he  goes  on  drinking  recklessly  day  after  day,  often 
in  secret,  wdien  he  has  broken  out  into  a  debauch,  and  does 
nothing  else  but  drink  until  he  can  take  no  food,  suffers  from 
persistent  vomiting,  and  is  compelled  to  stop  because  his  stomach 
rejects  instantly  whatever  he  swallows.  One  is  forced  to  recog- 
nise disease  rather  than  vice  in  the  spectacle  when  one  takes 
note  of  the  many  instances  in  which  men  and  women  of  good 
means,  in  high  social  position,  and  having  perhaps  superior 
intellectual  endowments,  abandon  themselves  from  time  to  time 
without  restraint  to  orgies  of  pure  drunkenness,  notwithstanding 
the  most  solemn  resolutions  to  abstain  which  they  may  have 
made  when  they  w^ere  sober  and  in  their  right  minds  ;  reckless 


488  PATHOLOGY  OF  AIIND.  [<  hap.  ix 

of  consequences,  defiant  of  all  social  proprieties,  to  tlie  ruin  of 
themselves  and  their  families,  consorting  during  their  paroxysms 
with  the  lowest  of  the  low,  and  sinking  to  the  meanest  shifts 
and  the  basest  degradation  in  order  to  obtain  the  means  of 
gratifying  the  craving.  When  the  paroxysm  is  over  they  are  sad 
and  penitent,  dilapidated  and  wretched,  bitterly  self-reproachful 
and  full  of  good  resolves,  and  return  to  their  social  sphere  to 
perform  their  duties  with  regularity  and  propriety  until  the  next 
outburst  takes  place.  In  their  sane  intervals  of  sobriety  these 
persons  oftentimes  evince  no  unusual  inclination  to  stimulants, 
and  are  perhaps  exceedingly  moderate  in  what  they  take ;  yet 
when  the  craving  comes  upon  them,  as  it  seems  to  do  with 
gathered  force  after  a  period  of  sobriety,  they  yield  unrestrained 
submission  to  it,  and  go  through  the  same  miserable  experience 
as  before.  Their  moral  nature  is  thoroughly  perverted  while  the 
paroxysm  is  on  them ;  they  are  given  over  to  deceit  and  lying 
and  cannot  in  the  least  be  depended  upon,  and  the  wife  may 
evince  violent  dislike  of  the  husband,  or  the  husband  a  hatred 
of  his  wife. 

The  malady  calls  to  mind  recurrent  mania  and  epilepsy — 
first  of  all,  by  its  common  periodic  character;  secondly  by 
the  profound  change  of  moral  character  with  wdiich  it  is 
accompanied ;  thirdly,  by  the  exact  repetition  which  one 
paroxysm  is  of  another  in  its  mode  of  onset,  in  its  features  and 
in  its  course;  and  lastly,  by  the  permanent  deterioration  of 
mind  which  it  produces  in  the  end  when  it  goes  on  unchecked. 
And  it  commonly  does  go  on  without  effectual  check,  since  the 
restraint  necessary  to  do  any  good  cannot  be  legally  enforced. 
It  is  true  that  the  persons  may  be  persuaded  sometimes  to  place 
themselves  voluntarily  under  control,  and  that  they  will  submit 
to  it  so  long  as  they  are  in  their  sane  moods  and  do  not  there- 
fore need  it,  but  the  chances  are  that  they  evade  or  repudiate  it 
when,  the  craving  comes  upon  them  and  restraint  is  truly  needed. 
The  condition  is  undoubtedly  oftentimes  hereditary,  or  the  out- 
come of  a  neurotic  temperament,  some  ancestors  or  relatives 
having  suffered  either  in  the  same  way  or  from  some  otlier 
nervous  disorder. 


CHAPTER  X. 

THE   LIOEBID   ANATOLIY   OF   I\IENTAL   DEEANGEMENT. 

Befoee  going  on  to  describe  tlie  morbid  cerebral  changes  which 
have  been  met  with  in  mental  disease  some  preliminary  con- 
siderations of  a  general  character  will  not  be  amiss,  the  less  so 
as  one  is  compelled  to  begin  with  the  acknowledgment  that 
there  may  be  no  morbid  appearances  at  all.  This  absence  of 
discoverable  physical  changes  where  marked  mental  disorder 
has  existed  necessarily  renders  a  chapter  on  morbid  anatomy  the 
most  barren  chapter  in  a  book  on  mental  pathology.  A  patient 
dies  raving  mad,  and  yet  the  examination  after  death  shall  not 
perhaps  disclose  the  reason  wdiy  he  was  mad  or  even  w^hy  he 
died.  To  conclude  thence,  however,  that  nerve  element  does  not 
subserve  mental  function,  or  is  not  affected  when  function  is 
affected,  is  to  make  a  hasty  and  unwarranted  inference.  At 
present  we  know  nothing  whatever  of  the  intimate  molecular 
constitution  of  nerve  element  and  of  the  mode  of  its  functional 
action,  and  it  is  beyond  doubt  that  important  molecular  and 
chemical  changes  may  take  place  in  those  inner  recesses  to  w^hich 
our  senses  have  not  gained  access.  The  cerebral  nerve-cells 
are  minute  laboratories — chemical  and  physiological — in  which 
not  only  are  the  most  complex  chemical  processes  in  the  world 
carried  on  unceasingly,  but  vital  processes  also  wdiich,  material- 
ising experiences  in  structure,  condition  or  determine  their  inti- 
mate constitution.  And  yet  all  these  processes  are  hidden  from 
our  present  means  of  observation.  Where  the  subtilty  of  nature 
60  far  exceeds  the  subtilty  of  human  investigation,  to  conclude 
from  the  non-appearance  of  change  to  the  non-existence  thereof 


490  PATHOLOGY  OF  MIND.  [chap. 

would  be  just  as  if  the  blind  man  were  to  maintain  that  there 
were  no  colours,  or  the  deaf  man  to  assert  that  there  was  no  sound. 
Justly  then  may  we  with  Pinel  rather  doubt  the  sufficiency  of  our 
senses  than  believe  that  mental  disorder  can  exist  without  any 
physical  disorder  in  the  brain,  and  rest  in  the  certitude  that  in 
the  fulness  of  time  a  means  will  be  discovered  to  penetrate  the 
yet  inscrutable  recesses  of  nerve  life,  and  to  make  known  the 
physical  conditions  of  its  functional  manifestations.  That  it  is 
now  a  region  of  uncertainties  and  obscurities  may  be  taken  as 
promise  that  it  is  the  destined  field  of  future  discoveries.   - 

There  are  many  facts  to  prove  that  serious  modifications  in 
the  constitution  of  nerve  element  take  place  without  any  other 
evidence  of  them  than  we  infer  from  correlative  chanoes  of 
energy.  After  severe  and  prolonged  mental  exertion  there 
ensues  exhaustion,  which  may  be  so  great  that  the  brain  is 
utterly  incapacitated  from  further  function ;  a  large  increase  of 
phosphates  in  the  urine  bears  witness  to  the  disintegration  of 
nerve  ;  the  individual  is,  so  far  as  power  of  active  life  is  con- 
cerned, almost  a  nonenity;  and  yet  neither  microscopist  nor 
morbid  anatomist  would  succeed  in  discovering  any  difference 
between  the  nerve  substance  of  his  brain  and  the  nerve 
substance  of  the  brain  of  one  who,  after  due  rest  and  nutrition, 
was  prepared  for  a  day  of  vigorous  activity.  The  sudden  shock 
of  a  powerful  emotion  has  produced  instantaneous  death,  just  as 
a  stroke  of  lightning  has,  and  perhaps  in  the  same  way;  but 
neither  in  the  one  case  nor  in  the  other  may  there  be  any  detect- 
able morbid  change.  If  the  electric  fish  is  persistently  irritated 
so  as  to  be  made  to  give  forth  shock  after  shock,  the  excessive 
expenditure  of  energy  leaves  it  utterly  exhausted,  and  it  can 
give  no  more  shocks  until  its  powers  have  been  restored  by  rest 
and  nutrition ;  its  nervous  centres  have  plainly  undergone  a 
considerable  modification,  though  we  know  not  the  nature  of  it. 
Instead  of  arterial  blood  send  through  the  brain  blood  heavily 
charged  with  carbonic  acid,  and  the  victim  of  the  experiment 
must  inevitably  die ;  but  no  one  can  describe  the  secret  change 
that  has  been  produced  in  the  composition  of  the  nerve  element. 
Without  killing  a  person  outright,  it  is  possible,  by  causing 
him  to  breathe  a  mixture  of  one  part  of  air  and  three  parts  of 


X  ]    MORBID  ANATOMY  OF  MENTAL  DERANGEMENT.    491 

carbonic  acid,  to  render  him  as  insensible  to  pain  as  if  he  had 
inhaled  chloroform;  but  it  is  the  gross  result  only  that  is 
recognisable  by  our  senses.  In  this  regard,  however,  the  experi- 
ments of  Lister  on  the  early  stages  of  inflammation  are  of  some 
interest ;  for  he  showed  that  carbonic  acid  produced  a  direct 
sedative  effect  upon  the  elements  of  the  tissue,  paralysing  for  the 
time  their  vital  energies ;  the  effect  being  transient,  and  the  tissue 
recovering  its  energy  after  a  considerable  time.  The  experiment 
brings  us  to  the  individual  elements  of  the  tissue,  but  no  farther ; 
it  tells  us  nothing  of  the  more  intimate  changes  that  take  place 
in  them.  It  is  obvious  that  the  difference  may  be  the  difference 
between  life  and  death,  and  yet  there  may  be  no  appreciable 
j)hysical  or  chemical  change. 

As  regards  morbid  appearances  in  cases  of  insanity,  there  can 
be  no  question  that  the  instances  in  which  they  are  not  found 
become  less  frequent  as  investigation  becomes  more  searching 
and  efficient ;  and  those  who  are  best  capable  of  judging,  and 
best  fitted  by  acquirements  to  give  an  opinion,  are  those  who  are 
most  certain  of  the  invariable  existence  of  organic  change. 
When  a  morbid  poison  acts  on  the  body  with  its  greatest  inten- 
sity there  are  fewer  traces  of  organic  alteration  of  structure  met 
with  than  in  cases  where  the  poison  has  been  milder  and  has 
acted  more  slowly;  and  so  likewise  organic  change  of  nerve 
element  in  insanity,  appreciable  by  the  imperfect  means  of 
investigation  which  we  yet  possess,  raay  justly  be  expected  only 
when  the  degeneration  has  been  going  on  for  a  long  time.  In 
truth  I  might  not  unfitly  speak  of  the  morbid  changes  as 
(a)  ascopic  or  intramolecular,  they  being  matters  of  faith,  not 
of  observation ;  (b)  microscopic,  that  is,  such  as  are  disclosed  by 
the  microscope ;  and  (c)  macroscopic,  or  changes  that  are  visible 
by  the  naked  eye. 

The  many  careful  and  important  researches  into  the  physiology 
of  nerve  which  have  now^  been  carried  on  for  several  years  have 
made  it  more  easy  to  conceive  the  existence  of  undetectable 
organic  changes,  albeit  they  have  not  revealed  their  nature. 
They  have  been  of  real  service,  moreover,  in  freeing  the  con- 
sideration of  the  supreme  nervous  functions  from  those  vague 
metaphysical   conceptions   which   the   notion    of  mind  as   an 


492  PATHOLOGY  OF  MIND.  [chap. 

exalted  spiritual  entity  and  of  brain  as  its  humble  instrument 
have  reflected  upon  them,  and  in  making  them  fit  subjects  of 
scientific  inquiry  by  bringing  them  into  the  category  of  organic 
processes.  With  the  perfecting  of  present  and  the  discovery  of 
new  means  of  minute  investigation,  it  is  probable  we  may  have 
in  time  to  come  an  evolution  of  knowledge  of  nerve-function 
not  unlike  that  increased  knowledge  of  the  heavens  which 
followed  the  invention  of  the  telescope. 

One  of  the  first  things  that  has  been  made  clear  thus  far  is 
that  time  is  as  essential  an  element  in  the  intestine  motions  of 
nerves  as  it  is  in  the  motions  of  the  heavenly  bodies.  A  definite 
interval  is  necessary  for  the  propagation  of  a  stimulus  from 
the  peripheric  ending  of  a  nerve  to  its  central  ending  in  the 
brain  ;  and  when  the  stimulus  has  reached  the  brain,  there  is  an 
appreciable  interval,  about  one-tenth  of  a  second,  before  the  will 
can  transmit  the  message  to  the  nerves  of  the  muscle  so  as  to 
produce  motion.  This  time-rate  of  conduction  varies  in  different 
persons  and  at  different  periods  in  the  same  person,  according 
to  the  degree  of  attention ;  if  the  attention  be  slight,  the  period 
is  longer  and  less  regular,  but  if  the  attention  be  active,  then 
the  period  is  very  regular.  But  whether  the  attention  be  great 
or  little,  a  certain  time  must  elapse  from  the  moment  of  irrita- 
tion of  a  sensory  nerve  to  the  resulting  contraction  of  muscle ; 
and  a  message  from  the  great  toe  to  the  brain  will  take  an 
appreciably  longer  time  than  a  message  from  the  ear  or  face. 
There  is  a  considerable  delay  in  crossing  the  spinal  cord  by  the 
stimulation  in  a  simple  reflex  action ;  according  to  an  experiment 
by  Helmholtz,  more  than  twelve  times  the  time  required  for  the 
transmission  of  a  stimulation  through  the  sensory  and  motor 
nerves  is  required  to  cross  the  spinal  cord.  The  time-rate  of 
propagation,  again,  is  greatly  dependent  upon  the  temperature  of 
a  nerve;  cold  very  much  diminishes  it,  so  that  the  speed  may 
be  ten  times  less  in  a  cold  than  in  a  normal  nerve ;  and  in  a 
cold-blooded  animal,  like  the  frog,  the  rate  is  only  about  80  feet 
in  a  second,  while  in  man  it  is  about  180  feet  in  the  second. 
Haller  first  proposed  to  measure  this  speed  of  nervous  action, 
and  made  a  calculation  of  it  in  man  which  was  not  very  fa,r 
from  the  truth ;  but  after  him  no  one  seems  to  have  attempted 


X.]  xMORBID  ANATOMY  OF  MENTAL  DERANGEMENT.        493 

the  task,  and  Miiller  even  pronounced  it  impossible,  because  the 
time  seemed  to  him  infinitely  little  and  unmeasurable.  In  ex- 
periments on  frogs  poisoned  with  opium  or  nux  vomica,  he  could 
not  perceive  the  slightest  interval  of  time  between  the  stimulus 
applie'd  and  the  resulting  muscular  contraction.  However,  the 
rate  of  conduction  by  nerve  has  now  been  found  to  be  not  only 
measurable,  but  comparatively  moderate — not  to  be  compared 
with  the  infinitely  more  rapid  motion  of  electricity  and  light, 
less  even  than  the  rate  at  which  sound  travels,  about  the  same 
as  that  of  an  eagle's  flight,  and  only  a  little  quicker  than  the 
speed  of  a  racehorse  or  of  a  locomotive.  Instead  of  nervous 
action  being  due  to  the  instantaneous  passage  of  some  imponder- 
able or  psychical  principle,  conduction  by  a  nerve  depends  upon 
a  modification  of  its  molecular  constitution,  for  the  production 
of  which  a  certain  time  is  essentially  requisite. 

The  attempts  which  have  been  made  to  ascertain  the  time 
required  by  the  brain  for  a  volition  have  shown  clearly  that  it 
also  is  a  measurable  period,  and  that  it  differs  according  as  the 
person  is  prepared  beforehand  or  not  for  what  he  has  to  volun- 
tarily respond  to:  thus,  for  example,  Jaager  found  that  when  he 
received  an  electric  shock  on  one  side,  knowing  beforehand  that 
the  shock  was  to  be  on  that  side,  the  interval  between  it  and  the 
answering  signal  given  by  him  was  about  3^°oth  of  a  second;  but 
if  he  did  not  know  beforehand  on  which  side  the  shock  was  to 
be,  then  the  interval  between  shock  and  respondent  signal  was 
about  tVo^^  of  a  second,  that  is  to  say,  a  difference  of  xJotk  of 
a  second.  There  can  be  no  question  that  there  is  a  considerable 
variation  in  the  time  in  which  the  same  mental  functions  are 
performed  by  different  individuals,  in  consequence  of  original 
constitutional  differences,  and  by  the  same  individual  at  differ- 
ent times,  owing  to  transitory  conditions  of  the  psychical 
centres.  jSTo  one  who  has  done  intellectual  work  but  knows  the 
vast  difference  in  the  rapidity,  ease,  and  success  of  it  according 
to  good  or  ill  moods.  "  There  is,"  says  Locke,  "  a  kind  of  rest- 
iveness  in  almost  every  one's  mind.  Sometimes,  without  per- 
ceiving the  cause,  it  will  boggle  and  stand  still,  and  one  cannot 
get  it  a  step  forward ;  and  at  another  time  it  will  press  forward, 
and  there  is   no   holding  it   in."     The   oppression   of  mental 


494  PATHOLOGY  OF  MIND.  [cilip. 

suifering  is  notably  attended  with  great  sluggishness  of  thought, 
the  train  of  ideas  seeming  to  stand  still,  and  even  perception 
being  dull  and  imperfect.  In  some  forms  of  mental  disease  this 
defective  association  is  well  marked,  whilst  in  others  a  certain 
sort  of  association  is  wonderfully  quickened,  so  that 'ideas 
follow  one  another  with  extraordinary  rapidity,  or  like-sounding 
words  are  strung  together  in  the  most  incoherent  rhymes.  In 
many  cases  of  affection  of  the  brain,  as  in  recovery  from 
apoplectic  seizure  and  in  senile  decay,  a  considerable  time  must 
elapse  betw^een  a  question  asked  of  the  patient  and  his  reply : 
there  is,  so  to  speak,  a  deafness  of  the  mind,  which  both  per- 
ceives and  reacts  more  slowly  than  is  natural.^  The  time-rate 
of  the  function  is  probably  the  measure  of  the  molecular  activity 
which  is  the  condition  of  it. 

But  there  are  other  physiological  discoveries  which  may  help 
eventually  to  build  up  some  conception  of  the  physical  condi- 
tions of  mental  activity.  The  researches  of  Matteucci  and  Du 
Bois  Eeymond  into  the  electrical  relations  of  nerve  have  shown 
that  there  are  currents  of  electricity  engendered  in  nerve,  as  in 
other  animal  structures,  which  are  constantly  circulating  in  it. 
When  the  nerve  going  to  a  muscle  is  transmitting  to  it  the 
stimulus  to  contract,  there  is  a  diminution  of  the  nerve's  proper 
current,  and  the  needle  of  a  galvanometer  connected  with  it  ex- 
hibits a  negative  variation.  In  like  manner  sensation  has  been 
proved  to  be  accompanied  by  a  negative  variation  of  the  nerve- 
current.  Matteucci  supposed  that  there  was  a  rapid  succession 
of  electric  discharges  from  nerve  and  muscle  during  activity, 
and  although  that  supposition  has  not  been  confirmed,  there 
can  be  no  doubt  that  the  neo^ative  variation  of  the  needle  of  the 

^  ''  Every  one  must  have  noticed  the  slowness,  as  well  as  difficulty,  Avilli 
which  the  tongue  is  put  out,  the  eyelids  raised,  or  words  uttered  by  patients 
in  a  semi-comatose  state.  It  seems  as  if  a  certain  time  were  needed, 
either  for  concentration  or  transmission  of  nervous  power,  before  the 
intended  action  can  be  begun  ;  while  so  much  hibour  is  necessary  in  pur- 
suing it,  that  I  have  repeatedly  observed  perspiration  breaking  out  from 
the  contiuued  effort  to  raise  a  palsied  arm,  and  an  exhaustion  to  follow, 
such  as  might  ensue  in  health  upon  violent  muscular  exercise  of  the  whole 
body.  How  striking  the  contrast  here  to  that  instant  and  free  effort  by 
which  action  is  evolved  almost  simultaneously  to  all  sense  with  the  external 
impression  producing  it,  though  various  mental  and  bodily  operations 
actually  intervene." — Sir  H.  Holland.  Chapters  on  Mental  Physiology. 


x]    MORBID  ANATOMY  OF  MENTAL  DERANGEMENT.    495 

galvanometer  marks  a  decrease  in  the  electromotive  force  of  tlie 
nerve,  and  that  this  decrease  is  in  some  way  "  intimately  related 
to  that  molecular  change  in  the  interior  of  the  nerve  which 
wdien  it  reaches  the  muscle  will  produce  contraction,  or  when 
it  reaches  the  brain  will  be  received  as  sensation."     It  is  to  be 
borne  in  mind  that  every  minute  particle  of  nerve  acts  according 
to  the  same  law  as  the  whole  nerve  ;  the  current,  therefore,  which 
a  piece  of  nerve  produces  in  a  circuit  of  which  it  forms  part  is 
to  be  considered  only  as  a  derived  portion  of  incomparably  more 
intense  currents  circulating  in  the  interior  of  the  nerve  around 
its  ultimate  particles.     There  is  thus  certain  evidence,  not  only 
of  electro-motor  properties  of  nerve,  but  of  a  modification  of 
these  during  functional  activity :  such  modification  again  testi- 
fying to  an  intimate  change  in  the  polar  molecules  of  the  nerve. 
The  results  prove  clearly  enough  that  nervous  functions  are 
not  to  be  embraced  in  any  metaphysical  conception,  nor  dismissed 
as  inexplicable.     Conduction  by  nerve  is  a  measurable  process 
of  molecular  movement ;  the  proper  electrical  current  of  nerve 
is  diminished  during  its  excitation,  and  its  intimate  molecular 
constitution  modified  ;  and  there  seem  to  be  reasons  to  suppose 
that  its  excitation  is  in  close  relations  with  those  chemical  oxi- 
dation changes   which  are  known  to  take  place  in  it  during 
activity,  rendering  its  reaction  acid,  and  giving  rise  to  similar 
products  of  retrograde  metamorphosis  to  those  which  are  pro- 
duced by  muscular  activity.     A  complete  and  adequate  theory 
of  nerve-function  must  take  into  account,  and  account  for,  all 
these  phenomena.     But  it  is  difficult  to  see  how  any  physico- 
chemical  theory  will  ever  embrace  all  the  phenomena  of  nervous 
function.     Certainly  life  is  a  great  deal  more  than  physics  or 
chemistry,  or  than  physics  and  chemistry,  as  physics  and  chem- 
istry are  known  to  us  at  present ;  in  the  functions  of  the  nervous 
centres  there  are  such  vital  acts  of  assimilation  of  experiences 
and  their  structuralisation  by  nutrition  as  no  physics  and  chem- 
istry that  we  yet  know  of  can  in  the  least  ajoproach  unto.    But 
while  no  person  in  his  senses  will  pretend  to  set  forth  a  physico- 
chemical  theory  of  the  mood  of  a  lover,  of  the  imagination  of  a 
philosopher,  of  the  delusion  of  a  monomaniac,  it  is  not  a  whit  less 
unwarrantable  to  fly  incontinently  to  the  conclusion  that  such 
22 


496  PATHOLOGY  OF  MIND.  [chap. 

mental  plieuoineiia  are  independent  of  physical  organisation  ;  it 
does  not  follow  that  they  have  not  a  material  basis  because  they 
are  not  physical  and  chemical ;  and  it  is  bey  end  doubt  that  they 
are  as  essentially  dependent  upon  nerve-structure  as  the  move- 
ment of  a  limb  is  upon  its  muscles,  whether  any  more  spiritual 
than  it  or  not.  How  is  it  that  those  persons  who  look  down  witli 
scorn  and  contempt  on  the  doctrine  of  materialism  from  their 
high  intellectual  and  moral  platform  have  not  hitherto  invented  a 
spermatozoic  soul  to  have  and  account  for  those  wonderful  latent 
potentialities  Avhich,  albeit  the  spermatozoon  plainly  has  them, 
they  are  unable  in  the  least  to  detect  in  its  material  substance  ? 

When  we  consider  that  one  molecule  of  nerve-element  is  pro- 
bably more  complex  in  constitution  than  the  entire  solar  system, 
and  that  we  have  not  access  to  the  observation  of  its  intricate 
intestine  movements,  so  far  from  its  being  surprising  that  there 
are  no  visible  morbid  appearances  in  some  cases  of  insanity,  the 
wonder  is  that  they  should  have  been  expected.  If  a  distinct 
sensation  of  smell  is  caused  by  ^i-^olooo  g^«  of  oil  of  resin,  as  has 
been  calculated,  and  even  by  a  still  smaller  quantity  of  musk,  it  is 
surely  no  little  inconsistent  to  look  with  the  naked  eye  for  the 
physical  condition  of  psychical  disorder  and  to  talk  of  a  patho- 
logical classification  of  mental  disorders.  The  microscope  must 
be  used  in  order  to  observe  the  spermatozoon  and  ovum — minute 
and  almost  homogeneous  substances  to  look  at — which  never- 
theless contain  in  some  mysterious  fashion  those  multitudinous 
qualities  of  parents  and  ancestors  that  are  subsequently  deve- 
loped in  the  mental  and  bodily  characters  of  the  offspring  or, 
lying  dormant  in  them,  are  transmitted  through  their  sperma- 
tozoa or  ova  to  another  generation.  Whosoever  is  clever  enough 
to  discover  and  describe  the  physical  basis  of  the  multitudinous 
qualities  that  are  latent  in  the  spermatozoon  may  perhaps  suc- 
ceed in  discovering  and  describing  the  physical  basis  of  a  mo- 
nomaniac's morbid  suspicion,  and  of  the  warped  thought  of  a 
person  predisposed  hereditarily  to  insanity. 

The  foregoing  considerations  explanatory  of  the  absence  of 
detectable  morbid  changes  in  some  cases  of  insanity  are  entirely 
borne  out  by  our  experience  of  such  severe  nervous  diseases  as 
epilepsy,  tetanus,  hydrophobia,  and   neuralgia. .   Not  the  least 


X.]    MOKBID  ANATOMY  OF  MENTAL  DERANGEMENT.    497 

change  after  death  in  any  one  of  these  instances  may  be  found 
to  account  for  the  furious  storm  of  symptoms  during  life,  not 
even  when  the  disease  has  been  the  direct  cause  of  death.  And 
just  as  it  is  certain  that  epilepsy  or  tetanus  or  neuralgia  may 
be  caused  by  an  eccentric  irritation,  and  be  therefore  a  reflex  or 
sympathetic  disorder,  so  it  is  certain  that  in  some  cases  an  attack 
of  mental  derangement,  being  provoked  and  kept  up  by  disease 
elsewhere  than  in  the  brain,  is  also  essentially  reflex  or  sympa- 
thetic. When  a  deep  melancholia  disappears  almost  instantly 
after  the  putting  right  of  a  prolapsed  uterus  it  is  obviously 
right  to  look  upon  the  mental  disorder  as  reflex  ;  and  in  such 
case  we  certainly  should  not  expect  to  find,  had  we  the  oppor- 
tunity to  examine,  morbid  appearances  in  the  brain.  But  this 
sympathetic  melancholia  may  be  quite  as  severe  in  its  symptoms 
as  melancholia  otherwise  caused :  why  then  think  it  strange  if 
there  are  no  morbid  appearances  in  the  latter  case  ? 

In  this  connection  it  is  important  to  bear  in  mind  that  the 
reflex  transmission  may  take  place  along  different  channels — 
not  from  sensation  to  motion  only,  but  also  from  sensation  to 
sensation,  from  motion  to  sensation,  from  motion  to  motion,  and 
from  sensation  or  motion  to  nutrition.  A  molecular  change  in 
the  interior  of  a  nerve  being  set  up  %j  the  primary  irritation, 
whatever  and  wherever  that  be,  is  carried  to  any  part  with 
which  it  is  in  connection  by  continuity  of  nerve-structure; 
when  the  molecular  agitation  reaches  a  motor  centre  it  is  reflex 
movement  or  reflex  paralysis ;  when  it  reaches  a  sensory  centre  it 
is  reflex  or  sympathetic  sensation ;  when  it  reaches  the  supreme 
ideational  centres  it  may  occasion  reflex  disorder  of  thought, 
feeling,  and  will ;  when  it  reaches  the  interior  of  a  gland  it 
may  modify  the  intimate  processes  of  secretion,  and  so  cause 
a  reflex  derangement  of  secretion ;  and  when  it  reaches  a  part 
which  is  not  sensitive,  which  does  not  contract,  which  does  not 
think,  feel,  or  will,  which  does  not  secrete,  it  may  still  give  rise 
to  a  perversion  of  nutrition  or  a  so-called  trophic  derangement. 
Let  me  give  examples :  When  severe  pain  is  felt  along  the  spine 
after  a  fit  of  sudden  and  violent  coughing,  when  the  throat 
tickles  after  speaking  for  a  long  time,  when  facial  neuralgia  is 
increased  by  muscular  exertion,  the  reflex  is  from  motion  to 


408  PATHOLOGY  OF  MIND.  [chap. 

sensation ;  when  pain  in  tlie  knee  is  felt  in  disease  of  tlie  hip- 
joint,  when  facial  neuralgia  is  caused  by  toothache,  when  the 
pain  of  a  toothache  is  felt  in  the  opposite  tooth  to  that  which 
is  carious,  the  reflex  is  from  sensation  to  sensation  ;  when  the 
muscles  of  a  paralysed  limb  in  a  hemiplegic  patient  contract 
daring  some  emotional  or  voluntary  act  in  which  the  corre- 
sponding muscles  of  tlie  opposite  limb  take  part,  it  is  from 
motion  to  motion;  when  the  suppuration  of  a  gland  in  the 
neck  is  kept  up  by  a  carious  tooth,  disappearing  soon  after  the 
tooth  is  extracted,  the  reflex  effect  is  shown  in  nutritive  dis- 
order. But  in  truth  the  various  symptoms  of  the  protsean 
disease,  hysteria,  furnish  examples  of  all  these  varieties  of  reflex 
action,  if  we  look  upon  them,  as  for  the  most  part  perhaps  we 
may,  as  mainly  the  effects  of  the  operation  of  the  reproductive 
organs  upon  a  somewhat  unstable  nervous  system :  we  meet 
with  deranged  thought,  moral  perversion,  impaired  will,  abnor- 
mal sensations  of  all  sorbs,  spasms  or  convulsions,  vaso-motor 
irregularities  and  disordered  secretion  and  nutrition  in  different 
cases,  and  often  enough  in  the  same  case.  Let  it  be  noted  as 
probable  that  the  reflex  action  may  be  both  directly  through 
nerve  upon  the  elements  of  the  tissue  or  indirectly  through  the 
vaso-motor  system. 

There  remains  yet  another  matter  to  be  taken  into  account  in 
explanation  of  the  absence  of  discoverable  morbid  changes  in 
insanity,  before  passing  from  the  subject — namely,  the  local  dis- 
turbances of  circulation,  which,  present  during  life,  may  have 
disappeared  after  death.  I  am  inclined  to  think  that  most 
waiters  on  insanity  have  laid  too  great  stress  upon  the  vascular 
changes  in  the  brain  and  its  membranes  which  are  undoubtedly 
frequently  met  with  in  connection  with  insanity,  in  so  far  as  they 
have  looked  upon  them  as  primary  agents  in  initiating  and  kee'p- 
ing  up  mental  disorder  ;  in  most  cases  they  might  more  justly 
have  set  them  down  as  effects  of  prolonged  mental  disturbance. 

The  truth  is  that  the  first  step  in  insanity  probably  is,  as  it  is 
in  inflammation,  a  direct  change  in  the  individual  elements  of 
the  tissue,  the  change  in  the  blood-vessels  being  secondary.  Take, 
for  illustration,  the  early  steps  of  inflammation :  by  the  obser- 
vations of  Professor  Lister  it  has  been  made  evident  that  in  the 


X.]  MOIJEID  ANATOMY  OF  MENTAL  DERANGE.MENT.        499 

case  of  mechanical  or  cliemical  injury  to  some  part  the  elements 
of  the  tissue  are  directly  injured;  they  are  brought  to  a  lower 
state  of  life,  and  tlieir  functional  activity  is  impaired ;  as  a  con- 
sequence of  the  injury  the  elements  are  brought  nearer  to  the 
condition  of  ordinary  non-living  matter,  the  blood-vessels  dilate, 
and  the  corpuscles  of  the  blood  exhibit  a  tendency  to  stick  to- 
gether in  the  neighbourhood  of  the  damaged  part,  just  as  they 
do  when  brought  into  contact  with  ordinary  matter  after  being 
"withdrawn  from  the  body.  The  dilatation  of  the  vessels  is  pro- 
duced indirectly  through  the  nervous  system.  Observation  of 
the  effects  of  irritants  upon  the  pigment-cells  of  the  frog's  skin 
confirmed  these  views  in  an  instructive  way :  Mr.  Lister  found 
that  when  irritants  were  applied  in  such  a  mild  form  as  to  cause 
little  or  no  derangement  of  the  blood,  they  did  nevertheless  pro- 
duce a  certain  degree  of  loss  of  power  in  the  elements  of  the 
part  to  which  they  were  applied  ;  for  there  took  place  a  diffusion 
of  the  pigment  in  the  cells,  which  he  declares  to  be  "  the  visible 
evidence  of  diminished  functional  activity  accompanying,  if  not 
preceding,  the  earliest  approaches  to  inflammatory  congestion," 
and  corresponding  with  arterial  dilatation.  Experiments  with 
carbonic  acid  proved  that  it  had  a  po\Yerful  sedative  effect  upon 
the  tissues  themselves,  paralysing  their  vital  energies  so  as  to 
give  rise  to  intense  inflammatory  congestion,  which,  however, 
was  transient ;  even  in  amputated,  limbs,  in  which  there  was  of 
course  no  circulation,  the  tissues  recovered  after  its  action,  so 
that,  as  the  restoration  of  the  action  of  cilia  separated  from  the 
body  might  indicate,  the  "  tissues  possess,  independently  of  the 
central  organ  of  the  nervous  system  or  of  the  circulation,  or  even 
of  the  presence  of  blood  within  the  vessels,  an  intrinsic  power 
of  recovery  from  irritation,  w-hen  it  has  not  been  carried  beyond 
a  certain  point."  ^  From  which  researches  it  appears  that  the 
earliest  condition  of  inflammation  is  some  damage  to  the  ele- 
ments of  the  tissues  and  a  more  or  less  complete  suspension 
of  their  functional  activity,  whatever  be  the  cause ;  and  it  is 
evident  also  that  the  walls  of  the  blood-vessels  are  more  or  less 
deprived  of  their  vital  endowments  when  inflammation  is  set 

1  "  On  the  Early  Stages  of  Inflammation,"  by  J.  Lister,  F.R.S.    Pldlo- 
sophical  Transactions,  vol,  xxsi,  1853. 


500  PATHOLOGY  OF  MIND.  [chap. 

up,  as  they  then  allow  fibrine  to  pass  readily  through,  though 
they  repel  it  in  health.  These  experimental  results  have  con- 
firmed the  opinions  of  those  philosophical  pathologists  who 
gave  due  weight  to  such  phenomena  as  the  immediate  effects 
of  mechanical  and  chemical  injury  of  a  part,  the  growth  of 
blood-vessels  in  the  primordial  development  of  parts,  and  the 
increased  action  of  one  kidney  and  the  sequent  increased  afflux 
of  blood  when  the  other  is  destroyed  or  rendered  incompetent.^ 

Bearing  well  in  mind  these  observations  respecting  the  in- 
trinsic action  of  the  tissues,  it  is  not  difficult  to  perceive  how 
damage  to  the  nerve  elements  of  the  brain,  however  caused — 
whether  from  overwork  or  emotional  anxiety,  or  some  poison  in 
the  blood,  or  sympathetic  irritation,  or  direct  injury — may  im- 
mediately manifest  itself  in  disordered  function :  the  nerve 
element  is  .brought  to  a  lower  state  of  life,  and  exhibits  its  de- 
viation from  the  normal  state  by  a  disturbance  of  function. 
And  as  in  inflammation  a  dilatation  of  the  blood-vessels,  a  de- 
termination of  blood,  and  an  adhesion  of  its  corpuscles  follow 
the  local  mischief,  so  here  a  disturbance  of  the  circulation  follows, 
and  in  its  turn  becomes  the  cause  of  further  mischief.  One  may 
perceive  also  how  it  is  that,  when  there  is  an  innate  feebleness 
of  nerve  element  in  consequence  of  hereditary  taint,  insanity  is 
produced  by  causes  that  would  have  no  such  baneful  effect  upon 
a  soundly  constituted  brain ;  for  the  weak  element  is  more  easily 
brouoiit  to  a  lower  state  of  life,  and  is  then  of  course  less  able 
to  contend  with  the  vascular  troubles  that  gather  round  it  and 
overwhelm  it. 

When  a  dog  is  poisoned  with  strychnia,  there  are  perhaps  no 
appreciable  morbid  appearances  in  the  animal's  body;  but  if 
any  are  found  they  are  congestion  of  the  spinal  cord,  aneuris- 
mal  dilatation  of  the  capillaries,  and  perhaps  small  effusions  of 
blood  in  the  grey  matter.  Now  the  congestion  or  effusion  of 
blood  in  such  case  is  plainly  a  secondary  result  of  the  intensely 
morbid  activity  of  the  nerve  elements  upon  which  the  strychnia 
directly  acts.  Here,  in  fact,  is  the  abstract  and  brief  chronicle 
of  what  may  be  presumed  to  happen  in  some  cases  of  insanity. 
Transfer  the  convulsive  action  from  the  spinal  nerve-cells  to 
1  General  Patlwlogy ,  by  J.  Simon,  F.R.S. 


X.]    MORBID  ANATOMY  OF  MENTAL  DERANGEMENT.   501 

the  cortical  colls  of  the  hemispheres,  the  result  is  an  acute 
and  violent  mania,  in  which  the  furious  morbid  action  of  the 
directly  poisoned  nervous  centres  initiates  an  acute  determina- 
tion of  blood.  Let  the  disease  become  chronic,  the  congestion  of 
the  blood-vessels  will  become  chronic  also.  The  common  prac- 
tice has  been  to  discover  the  pathological  cause  of  the  insanity 
in  the  congestion,  in  spite  of  the  patent  observation  that  it  was 
not  the  way  of  congestion,  otherwise  caused,  to  give  rise  to  in- 
sanity. In  what  is  described  as  Mania  transitoria,  an  individual 
falls  with  great  suddenness  perhaps  into  a  violent  fury,  in  which 
he  evinces  dangerous,  destructive,  and  even  homicidal  tenden- 
cies :  his  face  is  flushed,  his  head  hot,  and  there  is  plainly  an 
active  determination  of  blood  to  the  brain.  After  a  short  time 
the  attack  subsides,  and  the  man  is  himself  again,  scarcely 
conscious  of  what  has  happened  to  him.  There  is  not  good 
reason  to  look  upon  the  rush  of  blood  as  the  active  agent  in 
the  production  of  the  fury;  but  there  is  good  reason  to  look 
upon  it  as  secondary  to  the  violent  and  degenerate  action  of  the 
nerve-centres ;  in  truth,  the  attack  is  a  sort  of  epilej)sy  of  the 
cerebral  centres,  and  the  congestion  presumably  takes  place  much 
as  it  takes  place  in  the  spinal  cord  poisoned  by  strychnia.  To 
the  formation  of  correct  views  of  the  pathology  of  insanity  it 
is  very  necessary  that  this  possible  order  of  events  should  be 
distinctly  realised. 

At  the  same  time  it  is  important  not  to  overlook  or  underrate 
the  fact  that  extraneous  disturbances  of  the  circulation,  quanti- 
tative or  qualitative,  may  be  the  direct  cause  of  disorder  of  the 
cerebral  centres.  Whatever  interferes  with  the  regular  supply 
of  the  proper  material  to  be  assimilated  by  them,  and  the  regular 
removal  of  the  waste  products  of  function — whether  a  disturbed 
blood  supply  or  a  vitiated  blood — so  far  predisposes  to  disease, 
and  will  do  so  especially  where  there  is  any  innate  disposition 
to  morbid  action  or  any  prostration,  otherwise  caused,  of  nerve 
element.  In  his  Lumleian  Lectures  the  late  Dr.  Todd  insisted 
much  upon  what  Andral  had  pointed  out — namely,  that  an 
an£emic  condition  is  favourable  to  the  production  of  delirium 
and  of  coma. 

That  congestion  or  inflammation  of  the  brain  will  produce 


502  PATHOLOGY  0^  IMIND.  [chap. 

serious  disturbance  of  its  functions  is  known  to  every  one ;  but 
it  is  well  worth  considering  how  rarely  congestion  of  the  brain 
originating  in  causes  outside  itself  gives  rise  to  delirium  or  in- 
sanity, and  how  often  congestion  of  the  brain  has  been  found  after 
death  in  cases  where  there  was  no  symptom  of  mental  derange- 
ment during  life.  It  is  because  of  a  diminution  in  the  functional 
power  of  the  nerve  element  itself,  because  this  has  been  brought 
to  a  stage  nearer  to  the  condition  of  non-living  matter,  that  the 
adherence  of  the  blood-corpuscles  and  the  stagnation  of  the  blood 
take  place.  In  such  circumstances  we  may  understand  how 
little  fitted  the  nervous  element  is  to  contend  with  the  diffi- 
culties that  are  gathered  around  it:  it  is  weak,  and  it  is  con- 
sequently miserable  ;  evils  cluster  around  it,  and  threaten  to 
quench  its  life ;  it  has  more  difficult  work  to  do,  and  yet  it  is 
less  able  to  do  it ;  it  responds,  therefore,  as  weakness  always 
does,  with  a  convulsive  or  delirious  energy,  and,  if  circumstances 
continue  unfavourable,  its  activity  is  extinguished.  May  we  not, 
then,  perceive  how  it  is  that  the  abstraction  of  blood  by  some 
means  from  the  labouring  part  has  been  beneficial  in  certain 
cases  ?  The  aim  is  to  put  the  suffering  part  as  nearly  as  pos- 
sible in  that  condition  in  which  it  is  during  natural  sleep — in  a 
condition  of  rest ;  and  the  recovering  power  which,  as  w^e  have 
seen,  is  inherent  in  the  elements  of  living  tissue,  is  then  under 
the  most  propitious  conditions  for  restoring  the  natural  state  of 
things.^ 

Morhid  A'ppearances  in  the  Brain  and  Memhranes. — The 
morbid  changes  in  the  brain  that  are  discovered  by  the  micro- 
scope or  otherwise  certainly  do  not  admit  of  being  described 
so  definitely  as  to  throw  any  light  upon  the  pathology  of  the 
different   forms  of  mental  derangement ;    they  do  not  in  the 

1  Morel  mentions  the  case  of  a  man,  aged  fifty-five,  who  was  hemiplegic 
after  cerehral  hcemorrhage.  His  intelligence  was  sound,  but  he  was 
morose  and  irritable,  and  weary  of  life.  Periodically,  however,  he  was 
subject  to  attacks  in  which  he  complained  of  hlood  rising  to  the  head;  his 
heart  beat  violently  ;  the  fingers  of  the  paralysed  side  contracted  ;  he  was 
unspeakably  dejected  at  first,  saying  that  he  was  lost ;  then  became  furious, 
threw  himself  on  his  wife  or  children,  and  several  times  attempted  suicide. 
Blood-letting  and  cold  to  the  head  produced  immediate  calm. — Traiie  des 
Maladies  Mentahs  p.  138. 


X.]    MOnBID  ANATOMY  OF  MENTAL  DERANGEMENT.   503 

least  tell  us,  for  example,  wliy  the  disease  is  melancliolic  in  one 
case,  maniacal  in  another,  monomaniacal  in  a  third.  Some 
writers  deny  that  the  post-mortem  appearances  in  the  insane 
throw  any  light  on  the  nature  of  the  disease ;  and  the  belief 
affords  a  comfortable  excuse  for  shirking  laborious  and  tedious 
investigation.  Schroeder  van  der  Kolk,  however,  held  a  differ- 
ent opinion  : — "  More  than  thirty  years'  experience,"  he  says, "  has 
led  me  to  an  entirely  opposite  opinion,  and  I  do  not  remember 
to  have  performed,  during  the  last  twenty-five  years,  the  dis- 
section of  an  insane  person  who  did  not  afford  a  satisfactory 
explanation  of  the  phenomena  observed  during  life.  On  many 
occasions,  I  was  able  accurately  to  foretell  what  we  should 
find."  ^  It  must  be  confessed  that  no  other  person  of  authority 
has  expressed  or  felt  a  like  certitude. 

The  broad  result  of  pathological  observation  is,  that  the 
morbid  changes  that  are  most  constantly  met  with  after  insanity 
are  such  as  affect  the  surface  of  the  brain  and  the  membranes 
immediately  covering  it.  Of  these  changes  certainly  those  in 
the  layers  of  the  cortical  substance  are  the  essential.  The 
evidence  of  more  or  less  inflammation  of  the  membranes,  and 
especially  a  milky  opacity  of  the  arachnoid,  common  in  the 
insane,  is  also  common  enough  in  the  bodies  of  those  who  have 
not  died  insane.  Certain  observations  of  Schroeder  van  der 
Kolk  enable  us  to  perceive  how  this  may  happen.  In  the  first 
place,  he  has  remarked  that  adjacent  parts  which  are  of  differ- 
ent structure  are  not  readily  attacked  by  inflammation  in  equal 
degree — it  does  not  spread  from  like  to  unlike  tissue  by  any 
easy  infection  or  sympathy  as  it  does  from  element  to  element 
of  the  same  kind  of  tissue  :  the  intercostal  muscles,  for  example, 
are  almost  unaffected  when  acute  costal  pleurisy  exists ;  the 
muscular  wall  of  the  intestine  is  scarcely  affected  in  peritonitis : 
and  the  heart  substance  remains  sound,  in  spite  of  acute  peri- 
carditis and  effusion  into  the  pericardium.  So  is  it  with  the 
pia  mater  and  the  brain  substance  which  it  closely  envelopes : 
congestion,  inflammation,  and  effusion  may  take  place  in  it  while 
the  brain  itself  is  not  implicated,   and  exudation  between  the 

^  On  the  Minute  Structure  and  Functions  of  the  Medulla  OUongata. 
p.  231. 


604  PATHOLOGY  OF  MIND.  [chap. 

arachnoid  and  pia  mater  will  accordingly  be  found  after  death 
when  there  has  been  not  the  least  mental  derangement  during 
life.  In  the  second  place,  he  directs  particular  attention  to  the 
distribution  of  vessels  in  the  pia  mater :  while  most  of  the 
arteries  pass  down  from  it  into  the  substance  of  the  brain  and 
are  there  distributed  to  the  grey  matter  in  a  most  plenteous 
network,  the  blood  being  brought  back  to  the  membrane  by  a 
corresponding  series  of  veins,  there  are  in  addition  direct  chan- 
nels of  commimication  between  the  arteries  and  veins  in  the  pia 
mater  itself.^  In  that  anatomical  a,rrangement  there  is  obviously 
a  provision  by  which  temporary  disturbance  of  the  circulation 
may  leave  the  cortical  layers  of  the  brain  unaffected,  the  storm 
passing  over  them;  the  direct  communications  are  overflow 
channels,  as  it  were,  for  the  surplus  blood.  But  for  such  pro- 
vision it  would  be  a  wonder  that  any  one  escaped  serious 
mental  disturbance,  considering  the  frequent  changes  in  the 
cerebral  circulation  to  which  every  one  is  subject  and  the  ex- 
treme delicacy  of  nerve  element.  As  it  is,  vascular  disturbance 
seldom  remains  entirely  without  effect;  although  the  hemi- 
spheres are  not  themselves  sensitive  to  pain,  they  manifest  their 
sensibility  to  the  abnormal  blood-supply  by  a  feeling  of  unusual 
irritability  and  a  proneness  to  excitement  and  passion ;  and  this 
is  a  condition  of  things  which,  as  every  one's  experience  teaches, 
is  not  so  uncommon,  but  which  usually  soon  passes  away  with 
the  physical  cause  of  it. 

There  is  no  question  that  the  mind  suffers  when  the  inflam- 
matory action  in  the  membranes  does  seriously  implicate  the 
adjacent  cortical  layers ;  for,  without  claiming  the  delirium  of 
acute  meningitis  in  proof,  the  morbid  appearances  sometimes 
found  after  acute  insanity  afford  sufficient  evidence.  As  might 
be  expected,  the  appearances  of  acute  hypersp.mia  are  most 
marked  after  death  from  acute  delirious  mania.  In  the  case 
mentioned  in  a  former  chapter,^  the  pia  mater  was  strongly  in- 
jected, the  arachnoid  was  clouded  like  glass  that  has  been 
breathed  upon,  and  streaked  with  a  delicate  milky  opacity  along 
the  lines  of  the  vessels,  there  was  a  bulging  at  the  sulci  by  a 

^  Die  Patlwlogie  und  Therajne  der  psycTiisclien  Kranhheiien. 
2  Page  406. 


X.]    MORBID  ANATOMY  OF  MENTAL  DEHANGEMENT.   505 

clear  serous  fluid  beneath  it,  and  numerous  red  spots  were 
visible  in  the  white  substance  of  the  brain  when  it  was  cut 
into.  In  France  much  attention  has  been  given  to  the  morbid 
conditions  of  acute  maniacal  excitement  or  maniacal  delirium ; 
tliey  are  described  as  those  of  acute  hypertemia — namely,  great 
injection  of  the  pia  mater  with  spots  of  ecchymosis,  more  or 
less  discoloration  and  softening  of  the  cortical  layers — the  dis- 
coloration being  in  red  streaks  or  stains  with  spots  of  extra- 
vasated  blood,  and  the  softening  being  of  a  violet  or  pink  hue — 
and  increase  of  the  puncta  vasculosa  of  the  white  substance. 
Dr.  Eingrose  Atkins  has  recently  described  the  morbid  appear- 
ances observed  by  him  in  a  case  of  acute  insanity  which  ended 
fatally  within  a  week,  both  lungs  of  the  patient  being  found 
studded  with  miliary  tubercles  throughout  their  entire  substance. 
The  pia  mater  was  much  injected  and  there  were  numerous 
minute  extravasations  of  blood,  some  globular  and  others  strati- 
form in  appearance,  between  the  pia  mater  and  brain  substance 
both  on  the  surface  of-  the  convolutions  and  between  them 
where  the  pia  mater  dipped  down  into  the  sulci ;  some  of  the 
extravasations  were  visible  with  the  naked  eye,  others  with  a 
low  power  of  the  microscope.  There  were  none  in  the  brain 
substance  itself.^  Here  then  the  weakened  walls  of  the  over- 
full vessels  had  given  way  and  the  blood  had  escaped  in 
numerous  minute  extravasations.  As  patients  do  not  often  die 
suddenly  in  the  acute  stage  of  insanity,  opportunities  are  not 
given  to  examine  whether  this  pathological  condition  is  often 
met  with ;  but  it  is  certainly  not  invariably  met  with  when  they 
do  die  in  the  acute  stage,  and  is  more  likely  to  be  found  after 
death  during  the  delirium  of  fever  than  in  ordinary  systematised 
mania.  If  we  call  to  mind  what  has  already  been  said  of  the 
relation  of  nerve  element  to  the  blood-supply,  it  will  be  easy 
to  understand  how  this  may  happen,  as  also  how,  when  hy- 
peisemia  is  met  with,  it  ought  perhaps  to  be  regarded,  not  as 
direct  cause  of  the  mental  disorder,  but,  if  not  as  effect  of  it, 
in  the  light  of  a  concomitant  effect  of  a  common  cause.  With 
due  regard  to  this  possible  relation,  it  may  be  justly  said  that 
the  visible  morbid  appearances  of  acute  insanity  are  those   of 

1  Journal  of  Mental  Science,  1875. 


506  PATHOLOGY  OF  ]\IIKD.  [chap. 

acute  hypera3mia  of  the  brain.  There  are  no  appreciable  difter- 
ences  between  the  morbid  conditions  of  acute  mania  and  acute 
melancholia:  in  the  latter  it  more  frequently  happens  that 
anatomical  lesions  are  absent ;  and  when  they  are  present,  they 
have  been  said  to  mark  less  hypercemia  than  exists  in  acute 
mania,  and  to  be  attended  with  more  or  less  serous  exudation. 

The  cases  of  chronic  insanity  in  which  all  anatomical  lesions 
are  wanting  are  rare,  albeit  they  do  occur:  the  longer  the 
insanity  has  lasted,  the  more  evident  they  usually  are.  In 
most  instances  there  is  a  thickening  and  milky  opacity  of  the 
arachnoid ;  and  many  of  the  more  advanced  cases  exhibit 
a  degree  of  atrophy  of  the  brain,  especially  of  the  convolu- 
tions, effusion  of  serum  into  the  sub-arachnoid  space  to  fill 
the  void  made  by  the  shrunken  brain,  discoloration  of  the 
cortical  substance,  and  some  hardening  of  the  white  substance. 
The  pia  mater  is  oftentimes  more  or  less  firmly  and  generally 
adherent  to  the  surface  of  the  brain,  so  that  it  cannot  be  stripped 
off  without  tearing  the  latter ;  and  a  finely  granular  condition 
of  the  ependyma  of  the  ventricles,  with  its  frequent  adherence 
to  the  parts  beneath,  would  seem  to  bear  witness  to  a  previous 
sub-inflammatory  condition  :  granulations  of  the  arachnoid,  care- 
fully described  by  Meyer,  have  probably  a  like  interpretation. 
Of  the  granulations  of  the  ependyma  of  the  ventricles,  which 
were  noticed  by  Bayle  in  general  paralysis,  but  are  certainly 
not  peculiar  to  it,  as  they  have  been  asserted  to  be.  Dr.  I-ockhart 
Clarke  says  :  "  They  consist  of  globular  aggregations  of  the 
ordinary  epithelial  cells,  which,  in  a  natural  or  healthy  state, 
are  arranged  side  by  side,  and  form  a  smooth  or  level  surface  on 
the  floor  of  the  ventricle.  The  tissue  immediately  subjacent, 
and  which  consists  of  exceedingly  fine  fibres  proceeding  from 
the  tapering  ends  of  the  epithelial  cells,  and  running  in  various 
directions,  was  more  abundant  than  usual ;  and — as  might  be 
expected  from  the  homologous  relation  of  this  part  to  that 
which  surrounds  the  spinal  canal — it  was  interspersed  with 
corpora  amylacea,  but  certainly  not  to  a  corresponding  extent."  ^ 
Although  the  adhesion  of  the  pia  mater  to  the  surface  of  the 
brain  is  most  frequent  in  general  paralysis,  it  is  met  with  in 
1  Beale's  Archives  of  Medicine,  vol.  iii. 


X.]  MOI^BID  ANAT0:MY  of  mental  derangement.        507 

other  forms  of  chronic  insanity,  particularly  in  dementia  following 
epilepsy  and  alcoholism. 

General  paralysis  is  the  one  form  of  mental  disease  in  which, 
if  death  has  not  taken  place  early  in  its  course,  we  may  be  sure 
of  finding  morbid  changes.  These  are  great  oedema  of  the 
membranes,  opacity  and  thickening  of  arachnoid  in  various 
degrees,  adhesion  of  the  pia  mater  to  the  surface  of  the  brain, 
larger  or  smaller  portions  of  wdiicb  are  torn  away  with  it  when 
it  is  removed,  greyish-red  local  softening  or  discoloration  of  the 
cortical  layers,  and  superficial  induration  thereof,  owing  to  an 
increase  of  the  connective  tissue  and  a  destruction  of  the  proper 
nervous  elements.  More  or  less  atropliy  of  the  vi^hole  brain, 
and  particularly  of  the  convolutions,  is  common,  and  is  accom- 
panied with  greater  firmness  of  its  substance,  enlargement  oi" 
the  ventricles,  and  serous  effusion  into  them.  Diffuse  pachymen- 
ingitis and  considerable  effusions  of  blood  into  the  membranes  or 
into  the  new  formed  layers  of  exudations,  as  described  by 
Virchow  and  Eokitansky,  are  not  unfrequent ;  these  effusions  be- 
ing no  doubt  the  cause  of  the  apoplectiform  attacks  which  occur 
in  the  later  stages  of  the  disease.  The  degeneration  of  the  nerve- 
substance  from  the  increase  of  connective  tissue  has  been 
observed  by  Eokitansky  and  others  to  extend  sometimes  even  to 
the  spinal  cord  ;  but  Westphal  has  more  recently  expressed  a 
doubt  whether  an  increase  of  connective  tissue  has  been  satis- 
factorily demonstrated  in  the  grey  and  white  substance  of  tlie 
brain,  although  he  has  no  doubt  of  its  occurrence  in  the  posterior 
columns  of  the  spinal  cord.  The  morbid  changes  described  are 
certainly  more  evident  in  general  paralysis  than  in  any  other 
form  of  insanity,  but  they  do  not  occur  with  uniform  constancy, 
nor  are  they  of  uniform  character ;  in  some  cases  the  meningitis 
being  most  marked,  in  others  the  atrophy  of  the  brain,  and  in 
others  the  induration  thereof.  Dr.  Sankey  has  made  a  careful 
comparison  of  the  morbid  appearances  observed  by  him  in 
fifteen  cases  of  general  paralysis  with  those  observed  in  fifteen 
cases  of  chronic  insanity  of  other  forms.  The  greatest  differ- 
ence was  in  the  frequency  of  effusion  beneath  the  arachnoid, 
which  was  found  in  eleven  of  the  fifteen  cases  of  general 
paralysis,  and  in  only  three  of  the  other  cases.     Adhesion  of 


508  PATHOLOGY  OF  MIND.  [chap. 

the  pia  mater  to  the  grey  matter  occurred  in  eight  of  the 
general  paralytics,  and  in  only  one  of  the  others.  The  convolu- 
tions were  abnormally  open  and  wide  apart  in  nine  of  the  cases 
of  general  paralysis,  and  in  three  of  the  other  cases ;  in  eight  of 
the  former,  again,  there  was  a  dark  discoloration  of  the  grey 
matter,  which  was  met  with  in  only  three  of  the  latter ;  the 
layers  of  the  grey  matter  were  indistinctly  marked  in  ten  cases 
of  general  paralysis,  and  in  six  of  the  other  cases.^  Plainly 
there  are  no  morbid  appearances  characteristic  of  general 
paralysis,  although  morbid  changes  are  more  marked  and  more 
constant  in  it.  Dr.  Mickle  has  recently  attempted  to  group 
cases  of  general  paralysis  into  varieties  according  to  the  differ- 
ences in  the  character  and  situation  of  the  morbid  changes 
which  he  has  found  in  the  brain,  and  to  indicate  the  clinical 
features  which  he  has  observed  to  belong  to  these  pathological 
varieties.  In  this  way  he  has  provisionally  sketched  the  patho- 
logical and  clinical  characters  of  five  special  groups.''^ 

Schroeder  van  der  Kolk  has  given  a  detailed  description  of 
several  cases  of  what  is  commonly  considered  a  very  rare 
affection,  but  which  he  thought  by  no  means  so  uncommon — 
namely,  a  diffuse  inflammation  of  the  dura  mater  or  an  idio- 
pathic pachymeningitis.  It  was,  he  thought,  often  overlooked, 
and  considered  to  be  rheumatic  headache.  The  symptoms  were 
intolerable  headache,  delirium,  sometimes  calmer  delusion,  and 
coma;  and  after  death  the  dura  mater  was  found  to  be  ex- 
tensively inflamed,  and  more  or  less  adherent  to  one  or  both 
hemispheres ;  the  inflammation  had  in  some  cases  extended  to 
the  brain,  which  was  found  to  be  softened.  According  to  his 
experience,  this  affection,  where  neither  syphilis  nor  injury 
could  be  assumed  as  cause,  was  not  rare.  A  remarkable  cir- 
cumstance in  regard  to  it  which  he  took  notice  of  was,  that 
regular  intermissions  occurred  in  its  course,  the  patient  having 
considerable  intervals  of  apparent  health. 

On  the  authority  of  so  eminent  an  observer  this  idiopathic 

1  '«0n  the  Pathology  of  General  Paresis,"  Journal  of  Mental  Science, 
1864. 

^  "Varieties  of  General  Paralysis  of  the  Insane."  Journal  of  Mental 
Science,  April.  1878. 


X]    MORBID  ANATOMY  OF  MENTAL  DERANGEMENT.    509 

inflammation  of  the  membranes  may  be  admitted,  but  it  must 
be  confessed  that  the  morbid  ai^pearances  described  by  him  are 
very  like  those  which  have  since  been  described  as  almost 
pathognomonic  of  syphilis.  A  diffuse  fibrinous  exudation  of 
low  form,  gluing  the  membranes  to  the  brain  substance  beneath, 
has  been  held  to  be  a  characteristic  feature  of  syphilitic  de- 
mentia. Instead  of  being  diffused  the  exudation  is  sometimes 
circumscribed,  so  as  to  have  the  form  of  a  tumour ;  and  it  may 
then  press  into  the  brain-substance,  causing  softening  im- 
mediately around  it.  Or,  again,  the  gum-like  exudation,  or 
syphiloma,  as  it  is  called,  may  take  place  as  a  diffuse  infiltration 
or  as  a  tumour  ^vithin  the  substance  of  the  brain,  the  mem- 
branes being  unaffected.  Such  is  the  morbid  product  which 
recent  researches  have  assigned  to  syphilis;  and,  according  to 
Virchow,  it  consists  at  the  outset,  like  the  substance  of  granu- 
lations, of  an  exuberant  growth  of  connective  tissue,  its 
further  development  taking  place  in  two  directions :  (1)  either 
the  formation  of  cells  predominates,  and  then  the  intercellular 
substance  is  soft,  jelly-like,  mucous,  or  fluid,  the  whole  mass 
remaining  jelly-like  and  coherent,  or  undergoing  purulent  de- 
generation ;  (2)  or  the  formation  of  cells  is  less  prolific,  and  the 
intercellular  substance  increases,  so  that  the  fibres  preponderate ; 
the  cells  are  spindle-shaped  or  stellate,  like  the  cells  of  con- 
nective tissue,  or  round  like  granulation  cells.  Ultimately 
yellow  patches  of  fatty  degeneration  appear  in  it.  There  cer- 
tainly is  no  character  whereby  this  exudation  can  be  dis- 
tinguished as  a  specific  product,  and  every  pathologist  admits 
the  difficulty  of  distinguishing  it  from  tubercle.  In  some  in- 
stances the  arteries  of  the  brain  are  surrounded  and  infiltrated 
with  this  gummatous  deposit,  their  walls  being  much  thickened 
and  their  channels  narrowed,  or  actually  closed  in  the  smaller 
vessels.^  Tlie  starting-point  of  its  formation  has  been  supposed 
by  Virchow  to  be  the  nuclei  of  the  connective  tissue  and  its 
equivalents ;  the  proper  elements  of  the  organ  undergoing 
atrophy  as   the   result  of  the   hypertrophy  of   the  connective 

1  Cases  are  described  in  Journal  of  Mental  Science,  vol.  xx.  p.  352  ;  also 
vol.  xxii.  p   615. 


510  PATHOLOGY  OF  MIND.  [cijap. 

tissue.^  The  form  of  mental  disorder  with  which  this  syphiloma 
is  associated  in  its  extreme  stage  is,  as  might  be  expected,  an 
extreme  paralytic  dementia. 

Such  are  the  morbid  appearances  that  have  been  seen  by 
the  naked  eye  in  cases  of  mental  derangement.  Obviously 
those  that  are  found  in  acute  disease  indicate  a  process  which 
is  of  the  nature  of  acute  hypersemia  or  actual  inflamma- 
tion, and  their  effect  will  be  to  interfere  seriously  with  the 
nutrition  and  function  of  the  nerve-elements  of  the  brain. 
Whether  they  and  the  maniacal  symptoms  stand  to  one 
another  in  the  direct  relation  of  cause  and  effect  or  not — and 
their  non-essential  concomitance  in  mania  weighs  heavily 
against  the  theory  of  such  a  precise  relationship — tliey  both 
witness  to  the  loss  of  the  natural  vital  equilibrium  and  to  tlie 
display  of  degenerate  vital  activity:  in  the  one  case  we  have 
the  marks  of  that  resolution  of  higher  into  lower  vitality 
which  we  agree  to  call  inflammation,  in  the  other  we  have  the 
symptoms  of  that  resolution  of  higher  into  lower  mind  which 
we  agree  to  call  mania.  Let  the  disorder  be  much  prolonged 
and  become  chronic  and  irreparable,  the  observed  morbid 
changes  still  tell  the  same  tale :  a  thickening  of  the  walls  of 
the  blood-vessels,  an  increase  of  the  connective  tissue,  and  an 
atrophy  of  the  proper  nerve-elements  bear  witness  to  vital 
degeneration  as  emphatically  as  does  the  mental  incoherence. 
In  the  difference  of  histological  dignity  between  a  nerve-cell 
and  a  connective  tissue  corpuscle  is  there  not  a  gap  as  great  as 
that  between  sound  mental  activity  and  dementia  ? 

Microscopic  examinations  of  the  brain  after  insanity  have 
added  something  to  our  knowledge  of  its  pathology  by  disclosing 
morbid  changes  in  the  blood-vessels,  in  the  neuroglia  or  so- 
called  connective  tissue,  and  in  the  nerve  elements  themselves. 
Still  there  is  far  from  being  agreement  among  different 
observers  concerning  what  they  find  ;  moreover  there  is  no  little 
reason  to  think  that  in  many  instances  the  appearances  which 
have   been    described    as    morbid    were   produced    artificially 

1  Virchow's  Archiv,  vol.  xv,  p.  217.  "  Das  Sypliilom,  oder  die  consti- 
tutionell-sypliilitische  Neubildung,"  von  E.  Wagner.  Archiv  der  Heil- 
kunde,  1863. 


X.]    MORBID  ANATOMY  OF  MENTAL  DERANGEMENT.    511 

by  the  treatment  to  which  the  brain-substance  had  been  sub- 
jected in  order  to  fit  it  for  minute  examination.  Most  pains 
liave  been  given  to  the  microscopic  examination  of  the  brain  in 
general  paralysis,  and  it  is  in  it  that  the  most  definite  morbid 
changes  have  been  met  with.  Eecent  observers  have  described 
masses  of  cells  adhering  to  the  vascular  walls  and  more  or  less 
filling  the  perivascular  spaces.  They  resemble,  and  appear  to 
be,  colourless  blood-corpuscles,  single  red  blood-corpuscles  being 
seen  here  and  there  among  them ;  and  at  a  later  period  there 
are  regular  small  extravasations  in  all  stages  of  pigmentary 
degeneration.  The  vessels  themselves  are  filled  and  crowded 
with  blood-corpuscles.  A  pretty  constant  result  has  been  to 
discover  an  exuberant  production  of  connective  tissue  in  long- 
standing insanity,  and  esjoecially  in  general  paralysis.  The  homo- 
geneous matrix  of  what  is  supposed  to  be  connective  tissue  lying 
between  and  supporting  the  nerve  elements  of  the  brain,  and 
continuous  with  the  ependyma  of  the  ventricles,  appears  to  be 
prone,  in  certain  circumstances,  to  undergo  an  undue  increase,  to 
the  detriment  of  the  higher  elements  of  the  part.  The  researches 
of  Kokitansky  and  Wedl  into  the  morbid  changes  in  general 
paralysis  have  also  made  known  a  more  or  less  diseased  state  of 
the  capillaries  of  the  cortical  substance  of  the  brain.  There  is 
a  certain  tortuosity  of  the  capillaries  apparent  in  almost  every 
case,  this  being  in  some  cases  only  a  simple  curve  or  twist,  in 
others  amounting  to  a  more  complex  twisting,  and  even  to  little 
knots  of  varicose  vessels.  Eound  the  capillaries  and  small 
arteries  and  veins  there  is  often  a  hyaline  deposit  of  what  is 
supposed  to  be  embryonic  connective  tissue,  beset  with  oblong 
nuclei ;  this  afterwards  becomes  more  and  more  fibrous,  so  that 
the  vessel  may  look  like  a  piece  of  connective  tissue  in  which 
granules  of  fat  or  calcareous  matter  are  occasionally  seen.  It  is 
thought  that  this  growth  of  connective  tissue  may  have  its 
starting-point,  not  only  from  the  nuclei  of  the  walls  of  the  blood- 
vessels, but  also  from  the  proper  nuclei  of  the  brain-substance. 
As  a  consequence  of  its  exuberant  increase,  the  nerve  elements 
as  well  as  the  delicate  capillaries  are  injured  or  destroyed;  "in 
the  grey  substance  the  ganglionic  cells  appear  inflated,  their 
continuations  are  undoubtedly  torn,  and  the  nerve-tubes  pene- 


512  PATHOLOGY  OF  MIND.  [chap. 

tratiug  the  grey  substance  are  destroyed."  Eokitansky  believes 
that  it  is  not  to  be  looked  upon  as  an  inflammatory  process, 
and  it  certainly  is  not  so  in  the  common  acceptation  of  the 
meaning  of  inflammation,  albeit  it  plainly  bears  witness  to  a 
deterioration  of  nutrition  very  like  that  which  accompanies  and 
marks  a  chronic  sub-inflammatory  derangement. 

In  respect  of  this  sheath  round  the  small  arteries  and  capil- 
laries it  must  be  borne  in  mind  that,  as  Lockhart  Clarke  and  Mr. 
Eobin  have  pointed  out,  in  every  healthy  brain  a  great  number 
of  the  capillaries  and  small  arteries  are  surrounded  by  secondary 
sheaths  precisely  similar  in  all  essential  particulars  to  those 
which  have  been  considered  as  morbid  products  in  general 
paralysis."^  The  difference  is  that  the  sheaths  are  often  less 
delicate  in  general  paralysis,  thicker,  more  conspicuous,  and  fre- 
quently darker  than  in  the  healthy  brain  ;  sometimes,  especially 
when  the  vessels  are  convoluted,  they  appear  as  fusiform  dilata- 
tions along  their  course.  Moreover,  while  in  the  healthy  brain 
granules  of  ha3matoidin  are  commonly  scanty,  and  frequently 
absent  altogether,  they  often  abound  in  general  paralysis, 
scattered  in  some  places,  collected  into  groups  in  others.  In  con- 
nection with  the  hypertrophied  tissue  are  amyloid  corpuscles, 
colloid  corpuscles,  calcareous  and  fatty  granules — all  being  pro- 
ducts of  a  retrograde  metamorphosis,  if  the  colloid  and  amyloid 
bodies  be  not,  as  some  suppose,  fragments  of  broken-up  nerve. 
There  are,  as  I  apprehend  the  matter,  two  ways  in  which  retro- 
grade products  are  formed :  first,  there  is  a  mal-nutrition,  or  a 
retrograde  nutritive  process,  whereby  the  vitality  not  being  at  the 
height  necessary  to  the  production  of  the  proper  elements,  there 
are  engendered  from  the  germinal  nuclei  elements  of  a  lower  kind 
— connective  tissue  instead  of  nerve ;  and,  secondly,  there  is  a 
retrograde-metamorphosis  of  the  formed  elements  of  the  parts. 

An  elaborate  examination  by  Dr.  E.  Eindfleisch  of  the  morbid 
changes  in  the  brain  and  spinal  cord  of  a  patient  who  died  from 
tabes  dorsalis,  and  in  different  parts  of  whose  brain  there  were 
numerous  patches  exhibiting  different  degrees  of  grey  degenera- 

1  "On  the  Morbid  Anatomy  of  the  Nervous  Centres  in  General  Paralysis 
of  the  Insane,"  by  J.  Lockhart  Clarke,  F.R.S.  Lancet,  September  1st, 
1866. 


X.]  MORBID  ANATOMY  OF  MENTAL  DERANGE]\IENT.        513 

tion  from  a  greyish  pulp  to  sclerosis  has  in  the  main  confirmed 
Eokitansky's  observations.  His  results  are  of  special  interest 
here  in  relation  to  those  varieties  of  general  paralysis  which 
begin  with  or  are  associated  with  symptoms  of  tabes  dorsalis. 
The  process  of  degeneration  seemed  to  begin  in  the  vessels,  as 
their  walls  were  enormously  thickened  by  a  number  of  cells  and 
nuclei,  and  their  diameter  was  increased.  This  first  stase  he 
considered  to  be  the  result  of  long-enduring  hypera^mia.  The 
neuroglia  or  hyaline  connective  tissue  next  undergoes  change, 
fibres  being  formed  in  the  amorphous  basis  substance  ;  the  nerve 
fibres  then  suffer  atrophy,  lose  their  medulla,  and  appear  to  con- 
sist of  axis  cylinder  and  sheath,  or  of  axis  cylinder  only.  As 
they  disappear,  the  connective  tissue  increases ;  numerous 
single  nuclei  appear  in  it,  as  also  groups  of  nuclei,  which  seem 
to  proceed  from  the  division  of  a  single  nucleus.  Eound  these 
groups  a  certain  quantity  of  finely  granular  substance  collects, 
so  that  cell-like  bodies  are  formed,  resembling  the  four-nucleated 
bodies  described  in  marrow  by  Kolliker  and  Eobin.  The  fibres 
of  the  connective  tissue  are  formed  out  of  the  basis  substance, 
Eindfleisch  believes,  but  are  probably  developed  in  organic  rela- 
tion to  the  nuclei.  At  a  still  later  sta<?e  retrooTessive  metamor- 
pilosis  sets  in  :  molecules  of  fat  appear  in  the  ganglionic  cells, 
according  to  Virchow,  and  as  they  increase  form  granular 
bodies ;  Eokitansky,  however,  thinks  these  bodies  proceed  from 
the  fragments  of  the  medulla  of  the  nerve  fibres.  So  also  is  it 
in  Eindfleisch's  opinion  with  the  amyloid  corpuscles  that  are 
found  :  the  nucleated  cells  of  the  connective  tissue  go  through 
the  amyloid  degeneration  ;  and  he  has  watched  every  stage  of 
the  transition  from  the  normal  cell  to  the  amyloid  corpuscle. 
When  by  fatty  degeneration  the  greater  number  of  nerve-cells 
have  been  converted  into  a  detritus  capable  of  being  absorbed, 
the  fine  elastic  fibres  contract,  get  closer  and  closer  together, 
and  remain  as  the  constituent  tissue  of  the  cicatrix,  which 
sometimes  causes  considerable  deformity ;  whole  sections  of 
nerve  substance  having  been  replaced  by  a  relatively  small 
quantity  of  an  unyielding,  compact,  dry  tissue.  There  are  then 
three  principal  stages  in  this  degenerative  process  : — (1)  a 
change  in  the  vessels,  whereby  there  must  be  a  great  hindrance 


514  PATHOLOGY  OF  MIND.  [chap. 

to  regular  nutrition  ;  (2)  atrophy  of  nerve  element,  either  in  con- 
sequence of  the  interference  with  its  nutrition  (Eindfleisch),  or 
from  the  growth  of  connective  tissue  (Eokitansky)  ;  and  (3)  the 
subsequent  metamorphosis  of  the  connective  tissue.^ 

Wassilief  has  described  the  results  of  a  microscopical  exami- 
nation of  the  brain  of  a  young  woman  who  died  from  hydro- 
phobia.2  Some  of  the  nerve-cells  of  the  medulla  appeared 
muddy,  their  contours  dimmed,  and  their  nuclei  obscured.  In 
the  interstitial  tissue  of  the  brain  were  a  number  of  round 
bodies  of  the  size  of  the  white  blood  corpuscles,  and  supposed 
to  be  exudated  white  blood  corpuscles  which  were  most 
numerous  in  the  vicinity  of  the  perivascular  spaces.  The  blood- 
vessels were  strongly  dilated  and  were  filled  with  blood  cor- 
puscles. In  the  perivascular  spaces,  especially  in  the  cortex  of 
the  hemispheres,  was  a  slightly  shining,  strongly  refracting 
hyaloid  substance,  which  was  very  striking ;  it  was  sometimes 
collected  round  the  vessel  so  as  to  form  an  irregular  ring 
and  perceptibly  to  narrow  it.  In  other  parts  of  the  brain  the 
perivascular  spaces  were  more  or  less  dilated. 

A  careful  microscopical  examination  of  the  brains  of  three 
idiots  has  been  made  by  Wedl.  The  changes  which  he  observed 
Avere  such  as  are  usually  met  with  in  atrophy  of  the  cortical 
layers.  In  the  pia  mater  and  the  convolutions  there  was  local 
obliteration  of  capillaries,  these  sometimes  having  the  appearance 
of  a  dirty  yellowish  band  of  connective  tissue  which,  like  other 
connective  tissue,  swelled  up  and  lost  its  wavy  lines  in  acetic 
acid.  Other  thickenings  in  the  capillaries  of  the  cortical  layers 
he  described  as  colloid :  these  were  knotty  swellings  in  their 
course  that  were  unaffected  by  acetic  acid.  Atheromatous  de- 
generation of  arteries,  veins,  and  capillaries  was  more  or  less 
marked  in  all  the  cases.  In  one  instance  the  small  arteries  and 
veins  and  the  capillaries  exhibited  funnel-like  dilatations,  owing 
to  a  proliferation  of  nuclei  that  lay  nestled  in  them  ;  and  a  trans- 
parent basis  substance  containing  many  oval  nuclei  surrounded 
the  capillaries  for  some  distance.     In  all  three  eases  there  was 

^  "  Histologisches  Detail  zu  der  grauen   Degeneration  "von  Geliirn   u. 
Eiickenmark,"  von  Dr.  E.  Eindfleisch.     Virchow's  ArcMv,  B.  vi. 
2  Centralblatt  f.  d.  vied,  Wissensch,  No.  36,  September,  1876. 


X.]    MORBID  ANATOMY  OF  MENTAL  DERANGEMENT.    515 

a  metamorphosis  of  the  contents  of  the  ganglionic  nerve-cells, 
the  noticeable  change  being  a  condensation  of  the  contents 
with  disappearance  of  the  nuclei — a  condition  which  called  to 
mind  the  colloid  degeneration  of  the  ganglionic  cells  of  the 
retina.^  It  has  been  recently  stated  that  the  commissural  fibres 
which  should  unite  neidibourino-  convolutions  have  been  found 

o  o 

absent  in  the  brains  of  some  idiots,  the  "  fibres  of  association  " 
(Meynert)  which  unite  distant  convolutions  being  present  only ; 
and  this  defect  has  been  supposed  to  be  the  reasoo  of  the 
defective  intelligence.^ 

It  appears,  then,  that  the  vital  degeneration  which  shows  itself 
in  an  increase  of  connective  tissue,  with  atrophy  and  destruc- 
tion of  nerve  element,  so  far  from  being  peculiar  to  general 
paralysis,  is  of  common  occurrence  in  insanity  of  long  standing. 
There  can  be  little  doubt  that  the  morbid  product  which  is 
thought  to  be  the  result  of  syphilitic  disease  is  of  like  nature ; 
and  Billroth  found  a  peculiar  gelatinous  degeneration  of  the 
cortex  of  the  cerebellum,  which  he  met  with  in  one  insane 
person,  to  consist  of  soft  connective  tissue.  This  proliferation 
of  connective  tissue  with  destruction  of  the  nerve  elements  has 
at  any  rate  been  now  observed  and  described  in  dementia  fol- 
lowing continued  insanity,  in  general  paralysis,  in  syphilitic 
dementia,  in  tabes  dorsalis,  and  in  congenital  idiocy.  No  wonder^ 
then,  that  the  clinical  features  of  paralytic  dementia,  general 
paralysis,  syphilitic  dementia,  and  alcoholic  dementia  are  some- 
times so  very  like  that  they  cannot  be  distinguished  symptoma- 
tically.  The  so-called  hypertrophy  of  the  brain  which  is  met 
with  sometimes  in  large-headed  imbeciles,  and  especially  in 
epileptic  imbeciles,  and  which  is  apt  to  be  hastily  mistaken  for 
hydrocephalus,  is  really  due  to  an  increase  of  the  connective 
tissue,  and  not  of  the  nerve-cells  and  fibres,  since  they,  with  the 
capillaries,  undergo  atrophy.  The  convolutions  of  the  brain  are 
flattened,  and  its  substance  is  hardened,  and,  when  cut  into, 
presents  a  clean,  pale,  glistening,  and  elastic  surface.     A  similar 

^  "  Histologische  Untersuchungen  iiber  Hirntlieile  drier  Salzburger 
Idioten,"  von  Dr.  C.  Wedl.  Zeitschrift  der  K.  K.  Gesellschaft  der  Aerzte 
in  Wi'en,  1863. 

^  Researches  on  Idiocy.  Dr.  Mierzejewski,  Journal  of  Mental  Science^ 
January,  1879. 


516  PATHOLOGY  OF  MIND.  [chap 

induration  may  occur  without  any  hypertrophy  ;  it  is  said  to  be 
a  distinct  result  of  long-continued  lead-poisoning  ;  and  M.  Brunet 
has  described  a  hypertrophy  of  the  brain  without  induration,  but 
due  to  an  increase  of  the  connective  tissue.  ^ 

Dr.  Howden  has  recently  described  the  morbid  changes  which 
he  found  in  a  case  of  senile  dementia  in  which  death  took  place 
from  coma.  The  brain  was  wasted,  much  serous  fluid  effused 
into  the  meshes  of  the  pia  mater,  the  ventricles  were  distended 
with  fluid,  and  the  vessels  at  the  base  of  the  brain  atheromatous. 
The  brain-cells  of  the  grey  matter  were  clouded  with  fuscous 
granules  which  almost  always  obscured  the  nucleus,  but  the 
granular  deposit  was  evidently  outside  the  cell- wall.  Many  of 
the  cells  had  a  shrunken  and  misshapen  appearance  ;  there  were 
many  amyloid  and  hyaline  bodies  in  the  outer  layers  of  the 
cortex ;  and  the  minute  vessels  in  the  grey  matter  were  almost 
universally  coated  with  granular  matter.  There  were  also  twist- 
ings  and  well-marked  aneurism al  dilatations  of  the  vessels  of 
the  pia  mater,  in  all  parts  of  which  were  found  miliary  aneurisms, 
such  as  have  been  observed  in  the  neisrhbourhood  of  a  cerebral 
clot,  varying  in  form  from  a  slight  bulging  to  a  round  swelling, 
and  the  walls  of  the  vessels  had  a  granular  look.  The  aneurisms 
were  most  numerous  near  a  thin  layer  of  semi-fluid  blood  and  a 
small  dark  clot.^ 

We  have  no  definite  and  complete  descriptions — nothing  more 
than  vague  intimations — of  the  morbid  changes  that  take  place 
in  the  cells  of  the  convolutions,  albeit  we  feel  sure  that  import- 
ant changes  do  take  place  in  them,  and  have  the  testimony  of 
many  observers  as  to  their  shrunken,  misshapen,  and  abnormal 
look  in  such  states  of  extreme  mental  disorganisation  as  dementia 
following  long-continued  derangement,  senile  dementia,  and 
congenital  idiocy.  Some  years  ago  a  German  observer.  Dr. 
Tigges,  described  an  increase  of  nuclei  in  the  ganglionic  cells  in 

^  Annales  Medico-Psychologiqiies,  1874.  He  gives  many  references  to 
French  papers  treating  of  hypertrophy  of  the  brain.  In  the  Journal  of 
Anatomy  and  Physiology  for  May,  1873,  is  a  description  of  the  brain  of  a 
hydrocephalic  epileptic  idiot,  the  right  lobe  of  whose  brain  was  several 
ounces  heavier  than  the  left ;  its  greater  weight  being  due  to  an  increase 
of  the  neuroglia. 

2  Journal  of  Mental  Science,  vol.  xx.  p.  587. 


X.]         MOrvBTD  ANATOMY  OF  MENTAL  DERANGEMENT.        517 

acute  insanity,  and  declared  that  the  numerous  scattered  nuclei, 
usually  thought  to  belong  to  the  connective  tissue,  had  really 
escaped  from  the  cells  through  rupture  of  their  walls  at  a  later 
stage  of  their  inflammatory  degeneration ;  but  I  am  not  aware 
that  these  observations  have  been  confirmed.^  Dr.  Meschede 
has  described  the  morbid  changes  of  the  first  stage  of  general 
paralysis  as  being  inflammatory  in  character,  and  the  later 
changes  as  those  of  fatty  and  pigmentary  degeneration  of  the 
o-ano'lionic  cells.^ 

Pigmentary  degeneration  has  been  met  with  in  the  gangliunic 
cells  of  the  brain  in  senile  atrophy,  in  dementia,  and  in  ad- 
vanced general  paralysis.  Schroeder  van  der  Kolk  found  the 
cells  of  the  medulla  spinalis  and  oblongata  to  be  darker  and 
more  opaque  in  old  age ;  and  in  one  case  of  dementia  after 
mania,  where  there  was  partial  paralysis  of  the  tongue,  the 
ganglionic  cells  forming  the  nuclei  of  the  hypoglossal  nerves 
were  in  a  state  of  blackish-brown  degeneration,  so  that  he  at 
first  mistook  them  for  little  points  of  blood.  On  more  careful 
examination,  however,  they  were  seen  to  be  degenerated  gang- 
lionic cells,  filled  with  granular  dark  brown  pigment.  Dr. 
Lockhart  Clarke  has  observed  similar  structural  chano'es  in 
general  paralysis.  "  These  changes,"  he  says,  "  consist  of  an 
increase  in  the  number  of  the  contained  pigment-granules, 
which  in  some  instances  completely  fill  the  cell.  In  other  in- 
stances, the  cell  loses  its  sharp  contour  and  looks  like  an 
irregular  heap  of  particles  read}^  to  fall  asunder."  In  regard  to 
this  form  of  degeneration,  certain  pigmentary  changes  that  have 
been  described  in  the  retina  are  not  without  interest.  In  what 
is  called  Retinitis  pigmentosa  there  are  found  scattered  over  the 
fundus  oculi  irregular  figures  of  deep  black  colour,  consisting 
of  pigment  apparently  in  the  substance  of  the  retina.  A  point 
of  interest  with  regard  to  these  cases  is,  that  they  occur  in  the 
same  family  and  are  accompanied  by  general  imperfection  of 
development.  Grafe  observed  this  degeneration  to  be  often- 
times of  hereditary  occurrence,  and  Liebreich  has  pointed  out 
that  many  subjects  of  the  defect  are  the  offspring  of  marriages 
of   consanguinity.     More   or   less   imperfection   of  the  mental 

1  ZeitscJirift  fiir  PsTjchiatrie,  B.  xx.  2  Yirchow's  ArcJiiv,  1865, 


518  PATHOLOGY  OF  MIND.  [chap. 

faculties  and  arrested  development  of  the  sexual  organs  usually 
co-exist ;  and  the  concurrence  of  mutism  and  cretinism  with 
Retinitis  pigmentosa  is  occasional.  Pigmentary  degeneration 
may  be  regarded  as  a  no  less  certain  retrograde  morbid  change 
in  the  brain  than  it  is  in  the  retina. 

Granules  of  earthy  matter  are  common  enough  in  connection 
with  the  hypertrophied  connective  tissue  of  long-continued 
and  extreme  insanity.  But  a  few  cases  have  also  been  men- 
tioned in  which  a  so-called  calcification  of  some  of  the  gans:- 
lionic  cells  of  the  brain  has  been  met  with.  Erlenmeyer  found 
the  commissure  of  the  optic  nerves  hardened  by  a  deposit  of 
calcareous  matter  in  the  brain  of  a  monomaniac  who  had  died 
with  epileptiform  convulsions.  It  had  been  first  deposited 
about  the  small  arteries  and  in  the  connective  tissue ;  and  the 
cells  had  afterwards  been  occupied  and  made  opaque  by  fine 
granules  of  what  appeared  to  be  phosphate  of  lime.  Forster, 
in  his  Atlas  of  Pathological  Anatomy,  describes  calcified  cells 
found  in  the  grey  substance  of  the  lumbar  enlargement  of  the 
spinal  cord  of  a  boy  whose  lower  extremities  were  paralysed. 
Heschl  met  with  what  he  calls  an  ossification  of  cells  in  the 
brain  of  a  patient,  aged  twenty-six,  who  had  died  melancholic : 
they  were  in  the  compact  substance  surrounding  a  small  hasmor- 
rhaghic  cavity  in  the  cortical  part  of  the  right  cerebral  hemi- 
sphere. Hydrochloric  acid  dissolved  the  granular  contents,  and 
left  the  cells  with  a  pale  outline  in  view.^  Dr.  Wilks  believes 
certain  bodies  which  he  found  in  the  brain  of  a  general  paralytic, 
in  whom  the  small  arteries  were  calcified,  to  have  been  gang- 
lionic cells  that  had  undergone  calcareous  degeneration."^  Some 
persons  may  find  an  interest  in  reflecting  that  a  similar  degene- 
ration takes  place  on  a  microscopic  scale  to  that  which  the 
whole  organism  must  undergo  at  last :  as  the  body  is  formed  out 
of  the  dust  of  the  earth  by  an  upward  transformation  of  matter 
and  force,  so  by  a  retrograde  metamorphosis  of  matter  and  corre- 
lative resolution  of  force  does  it,  in  parts  and  as  a  whole,  return 
to  the  earth  whereof  it  is  made. 

Such,  then,  are  the  morbid  changes  which  have  been  observed 

1  Schmidt's  Jarhiich,  1863. 

*  Journal  of  Mental  Science,  1864. 


X.]    MORBID  ANATOMY  OF  MENTAL  DERANGEMENT.    519 

and  described  in  the  bodies  of  insane  persons.  Obviously  those 
which  have  been  made  known  by  the  microscope — the  changes 
in  the  blood-vessels,  the  increase  of  connective  tissue,  the  de- 
generation of  nerve-cells — are  entirely  consistent  with  those 
which  are  visible  to  the  naked  eye,  in  setting  forth  a  story  of 
vital  degeneration  that  is  of  degradation  from  a  higher  to  a  lower 
life.  And  notwithstanding  the  admission  that  morbid  changes 
cannot  be  detected  in  every  case  of  insanity,  and  all  that  such 
an  admission  implies,  still  the  lesson  to  be  derived  from  the 
study  of  the  changes  which  are  seen  is  a  certitude  of  the  essen- 
tial dependence  of  mental  function  on  physical  structure  and  a 
strong  faith  in  the  existence  of  unseen  changjes  where  none  can 
yet  be  seen.  As  by  the  invention  of  a  suitable  sense- sharpening 
instrument  we  have  gone  below  macroscopic  into  microscopic 
anatomy,  so  may  we  hope  that  the  time  will  come  when  those 
who  come  after  us  shall  by  the  invention  of  new  instruments  of 
research  go  yet  deeper  into  the  discovery  of  the  hidden  changes 
which  I  have  called  ascopic. 

Morhid  Conditions  of  other  Organs. — Perhaps  the  most  frequent 
local  diseases  met  with  in  the  insane,  and  the  most  frequently 
fatal,  are  diseases  of  the  respiratory  organs.  Many  who  are  in  a 
low,  deteriorated  constitutional  state,  especially  the  demented 
paralytics,  succumb  to  a  diffuse  pneumonia  of  low  type.  The 
usual  symptoms  of  the  disease,  however,  are  rarely  marked,  being 
masked  by  the  madness ;  there  is  seldom  any  cough,  expectora- 
tion, or  pain ;  no  complaint  is  made  ;  there  may  be  little  or  no 
dyspnoea ;  and  the  only  ground  of  diagnosis  lies  in  the  physical 
signs.  Gangrene  of  the  lung  was  observed  by  Guislain  almost 
exclusively  amongst  the  melancholies  who  had  refused  nourish- 
ment and  died  of  exhaustion,  and  in  as  many  as  nine  such  cases 
out  of  thirteen ;  but  it  has  been  found  since  his  time  that  the 
disease  is  not  limited  to  those  who  refuse  food,  although  most 
frequent  amongst  them.  In  the  Vienna  Asylum  there  were,  out 
of  602  post-mortem  examinations  made  in  three  years,  fifteen 
cases  of  gangrene  of  the  lung.  Pain,  cough,  dyspnoea,  and  fever 
are  often  entirely  absent ;  there  is  prostration,  and  the  extremities 
are  cold ;  the  complexion  is  dusky  red  or  cyanotic ;  the  odour 
of  the  sputa  and  breath  becomes  intolerably  offensive;  extreme 
23 


520  PATHOLOGY  OF  MIND.  [cnAi-. 

weakness  is  increased  by  diarrhoea,  and  death  follows  within  a 
period  varying  from  ten  days  to  three  weeks. 

Almost  every  writer  on  insanity  has  called  attention  to  the  fre- 
quency oi  phthisis  pidmonalis  among  the  insane,  although  there 
is  far  from  being  agreement  as  to  the  proportion  of  cases  in 
which  it  occurs.  A  careful  comparison  of  the  statistics  of  several 
asylums  by  Von  Hagen  showed  that  on  an  average  about  one- 
fourth  of  the  deaths  were  attributed  to  phthisis  ;  but  this  pro- 
portion is  really  about  the  same  as  that  for  the  sane  population 
above  fourteen  years  of  age.  Out  of  1,082  deaths  which  occurred 
in  the  Eoyal  Edinburgh  Asylum  from  the  year  1842  to  1861, 
phthisis  was  the  assigned  cause  of  death  in  315,  or  in  nearly 
one-third  (Dr.  Clouston).  In  eight  of  the  American  asylums 
the  deaths  from  consumption  were,  according  to  Dr.  Workman, 
27  per  cent,  of  the  whole  number  of  deaths.  Dr.  Clouston  has 
however  proved  by  the  examination  of  a  series  of  carefully 
made  post-mortem  examinations  that  phthisis  was  the  assigned 
cause  of  death  in  only  73  of  136  men,  and  in  97  of  146  women, 
in  whose  bodies  tubercular  deposit  was  actually  found — that  is, 
in  little  more  than  half  of  those  in  whom  tubercle  really  existed. 
His  conclusion  is,  that  not  only  is  phthisis  a  more  frequently 
assigned  cause  of  death  amongst  the  insane  than  amongst  the 
sane,  but  that  tubercular  deposition  is  about  twice  as  frequent 
in  the  bodies  of  the  former  as  in  those  of  the  latter.  But  there 
is  reason  to  think  that  the  association  of  the  diseases  is  not 
essential,  but  accidental;  that  it  is  due  to  the  conditions  in 
which  the  insane,  congregated  in  great  numbers  in  large  asylums, 
live,  not  to  any  special  power  which  insanity  has  to  provoke 
phthisis,  or  phthisis  to  provoke  insanity. 

Observers,  agreed  as  to  the  frequency  of  the  occurrence  of 
disease  of  heart  in  the  insane,  differ  much  as  to  the  proportion 
of  cases  in  which  they  are  found :  Esquirol  found  them  in  one- 
fifteenth  of  his  melancholic  patients,  Webster  in  one-eighth,  Bayle 
in  one-sixth,  Calmeil  and  Thore  in  nearly  one-third.  The  obser- 
vations of  late  years  tend  to  lessen  the  exaggerated  proportion 
commonly  assumed ;  out  of  602  post-mortem  examinations  in 
the  Vienna  Asylum,  affections  of  the  heart  were  met  with  in 
about  one-eighth  of  the  cases;  and  in  some  of  these  the  disease 


X.]    MORBID  ANATOMY  OF  MENTAL  DERANGEMENT.    521 

was  very  slight.  All  such  statistics  are  of  small  value.  Until 
we  have  a  more  accurate  comparison  with  the  statistics  of  heart 
disease  in  the  sane  population  than  has  yet  been  made,  it  must 
remain  a  conjecture  whether  it  is  even  more  common  in  insane 
than  in  sane  people. 

There  is  nothing  special  to  be  said  concerning  diseases  of  the 
abdominal  organs  in  the  insane.  A  more  oi'  less  inflammatory 
state  of  the  intestinal  mucous  membrane  is  at  the  bottom  of  that 
colliquative  diarrhoea  which  at  last  carries  off  many  feeble 
patients,  mostly  those  suffering  from  paralytic  dementia,  but 
now  and  then  even  some  who  are  maniacal  or  melancholic.  A 
changed  position  of  the  colon,  the  transverse  portion  of  it  lying 
in  the  hypogastric  region  or  in  the  pelvis,  was  taken  particular 
notice  of  by  Esquirol,  but  is  not  now  thought  to  be  of  any  real 
importance  or  to  have  any  special  significance. 

All  sorts  of  disorders  of  one  or  more  of  the  abdominal  orcrans 
have  been  met  with  in  particular  cases,  but  not  one  in  any  con- 
stant relation  to  a  particular  form  of  insanity.  Eokitansky 
noticed  a  considerable  increase  and  induration  of  the  cceliac  asis 
in  a  case  of  hypochondriasis  with  great  wasting.  Cancer  of 
the  stomach,  liver,  or  of  some  other  part  has  been  discovered  in 
cases  where  there  existed  duringr  life  a  delusion  with  reeard  to 
some  animal  or  man  being  present  in  the  belly ;  in  one  notable 
case,  described  by  Esquirol,  where  delusions  of  this  sort  were 
most  extravagant,  there  was  chronic  peritonitis  which  had  glued 
together  the  intestines.  Diseases  of  the  sexual  organs  are,  as 
already  pointed  out,  of  some  importance  in  the  causation  of  in- 
sanity. In  the  female,  prolapsus  of  the  uterus,  fibrous  tumour 
of  the  uterus,  ovarian  cyst,  &c.,  may  in  some  few  cases  impart 
to  the  insanity  a  sexual  character,  or  become  the  occasions  of 
special  delusions ;  but  in  other  cases  of  like  disease  there  is 
no  sort  of  connection  traceable  between  the  character  of  the 
insanity  and  the  particular  disease.  However,  if  there  be  no 
such  special  relation,  we  shall  do  well  to  remember  that,  by 
reason  of  the  consensus  of  parts,  the  intimate  connection  and 
interaction  between  one  organ  and  another  as  parts  of  an  organic 
whole,  disorder  of  any  organ — dissentient  where  all  should  be 
consentient — may  still  conspire  with  other  predisposing  or  ex- 
citing causes  to  provoke  an  attack  of  mental  derancjement. 


CHAPTER  XI. 

THE   TREATMENT   OF   MENTAL   DISORDERS. 

In  no  otlier  disease  are  the  difficulties  of  treatment  so  great  as 
they  are  in  mental  disease.  The  intrinsic  difficulties  appertain- 
ing to  the  nature  of  obscure  disease  are  increased  and  multiplied 
by  the  social  prejudices  concerning  it ;  by  the  frequent  conceal- 
ments and  misrepresentations  on  the  part  of  friends,  who  may 
often  be  reckoned  on  to  mislead  rather  than  enlighten  the  physi- 
cian ;  by  the  necessity  of  removing  the  patient — probably  against 
his  will — from  the  care  of  his  relations  to  other  care  more  suited 
to  his  malady ;  by  the  unsatisfactory-  character  and  position  of 
the  institutions  for  the  reception  of  insane  persons  ;  and,  in  some 
measure  also,  by  the  necessary  stringency  of  lunacy  legislation. 
In  face  of  such  difficulties  one  may  sympathise  with  Casaubon 
when  he  says,  "  Let  others  admire  witches  and  magicians  as 
much  as  they  will,  who  by  their  art  can  bring  them  their  lost 
precious  things  and  jewels  :  I  honour  and  admire  a  good  physi- 
cian much  more  who  can  (as  God's  instrument),  by  the  knowledge 
of  nature,  bring  a  man  to  his  right  wits  again  when  he  has  lost 
them."  1 

The  cruelties  formerly  inflicted  upon  insane  persons  no  doubt 
originated  partly  in  the  distrust  and  fear  which  their  disease 
occasioned  and  were  kept  alive,  after  they  were  quite  out  of 
harmony  with  the  moral  feeling  of  the  day,  by  a  neglect  spring- 
ing from  the  desire  to  hide  madness  as  a  disgrace  ;  but  they  were 
in  part  legacies  from  the  superstition  which  looked  upon  the 

^  On  Enthusiasm, 


CH.  XL]        THE  TREATMENT  OF  MENTAL  DISORDERS.  523 

insane  as  possessed  by  evil  spirits  which  it  was  necessary  to 
expel  by  the  severest  penal  discipline  when  prayers  had  proved 
unavailing.  The  ancient  Egyptians  and  Greeks  used  humane 
and  rational  methods  of  treatment ;  it  was  only  after  the  Christian 
doctrine  of  possession  by  devils  had  taken  hold  of  the  minds  of 
men  that  the  worst  sort  of  treatment  of  which  history  gives 
account  came  into  force.  However  it  came  about,  the  end  was 
that  to  be  the  victim  of  the  most  pitiable  of  diseases  became  a 
reason  not  for  undergoing  the  most  patient  and  considerate 
medical  treatment,  but  for  being  subjected  to  the  harshest  mea- 
sures and  to  an  imprisonment  which  was  too  often  lifelong. 
To  shut  the  madman  from  gaze,  and,  if  possible,  from  memory — 
to  be  rid  of  his  offending  presence  at  any  cost — that  was  the  one 
thing  to  be  done,  and  fit  implements  were  not  wanting,  as  they 
never  have  been  when  wrong  was  to  be  done,  to  execute  what 
was  wished. 

The  great  and  beneficent  reform  which  was  conceived  and  ini- 
tiated by  Pinel  in  France  and  carried  out  in  this  country  by 
Conolly  and  others,  had  to  encounter  a  strong  phalanx  of  obstruc- 
tive prejudices,  selfish  indifference,  and  interested  opposition.  But 
it  triumphed,  and  for  many  years  the  revolution  in  the  treatment 
of  the  insane  has  been  quoted  as  one  of  the  proud  reforms  of  the 
century.  Still  there  lingers  a  deep  distrust  of  lunatic  asylums 
in  the  public  mind,  and  it  gets  angiy  expression  from  time  to 
time  in  vague  accusations.  The  distrust  is  partly  a  relic  of  the 
memory  of  their  past  evil  management ;  it  is  partly  the  result  of 
the  clamour  of  insane  persons  at  large  who  have  been  at  one 
time  in  confinement,  as  they  believe,  unjustly  ;  it  arises  in  greater 
degree  out  of  a  vigilant  and  active  jealousy  of  any  interference 
with  personal  liberty ;  and  it  is  most  of  all  due  to  the  fact  that 
many  asylums  belong  to  private  proprietors  whose  interest  may 
be  supposed  to  be  to  get  and  to  keep  as  many  patients  as  they 
can,  rather  than  to  cure  and  discharge  them.  Granting  full  weight 
to  these  suspicions,  there  is  still  reason  for  congratulating  our- 
selves on  the  vast  reform  which  has  been  accomplished,  when  we 
contrast  the  worst  complaints  made  now  with  the  accusations 
that  were  justly  made  some  years  ago.  A  Committee  of  the 
House  of  Commons  was  lately  appointed  at  the  instigation  of 


524  PATHOLOGY  OF  MIND.  [chap. 

those  who  were  dissatisfied  with  the  state  of  the  Lunacy  Laws, 
in  order  to  examine  whether  the  facilities  were  unduly  great  for 
consigning  people  to  asylums,  and  not  duly  great  for  obtaining 
their  discharge  from  them.  The  Committee  made  a  painstaking 
inquiry  which  extended  over  several  months,  taking  a  great  deal 
of  evidence,  including  the  evidence  of  those  who  believed  that 
they  had  been  improperly  confined  as  lunatics  ;  the  result  being 
that  they  did  not  discover  a  single  instance  of  a  sane  person 
having  been  confined  as  insane,  and  made  a  report  which  con- 
tained only  a  few  not  very  important  recommendations.  When 
this  report  is  compared  with  reports  made  by  two  former  Com- 
mittees of  the  House  of  Commons  it  plainly  shows  how  great  is 
the  progress  which  has  been  made. 

So  long  as  insane  persons  cannot  themselves  perceive  that  they 
are  out  of  their  minds,  there  will  be  some  who,  having  improved 
so  far  as  to  be  discharged  from  confinement  in  asylums,  without 
being  quite  recovered,  will  make  loud  complaints  against  the 
injustice  of  law^s  of  w^hich  they  consider  themselves  to  have  been 
victims.  JSTothing  short  of  the  abolition  of  restraint  of  every 
kind  in  insanity  could  prevent  the  recurrence  from  time  to  time 
of  outcries  of  that  sort.  And  that  is  a  freedom  which  the  most 
thoroughgoing  advocate  of  the  liberty  of  the  subject  would  not 
claim  for  them.  In  the  interests  of  society  antisocial  beings 
must  be  so  guarded  as  to  prevent  them  from  doing  serious  harm 
to  others  who  may  be  brought  in  contact  with  them  or  may  be 
dependent  upon  them.  In  their  own  true  interests,  too,  as  well 
as  in  the  interests  of  their  families  and  of  society,  it  would  seem 
right  that  morbid  varieties  of  the  race  should  be  brought  back, 
if  possible,  to  healthy  minds.  They  are  placed  in  confinement 
therefore  not  only  because  they  are  dangerous  to  themselves  or 
to  others,  but  in  order  that  they  may  have  the  medical  treatment 
which,  not  recking  themselves  that  they  are  ill,  they  will  not 
seek  or  will  not  accept — in  fact,  as  the  statutory  terms  express 
it,  as  "  fit  and  proper  persons  to  be  detained  under  care  and 
.  treatment." 

The  grave  and  anxious  question  in  a  particular  case  is 
whether  an  asylum  is  necessary  or  not.  The  accepted  notions 
regarding   insanity   not   many  years  ago  were — first,  that  the 


XL]  THE  TREATMENT  OF  MENTAL  DISORDERS.  525 

best  means  to  promote  the  recovery  of  a  person  who  was 
labouring  under  it  was  to  send  him  to  an  asylum ;  and, 
secondly,  that  so  long  as  he  was  insane  there  was  no  better 
place  for  him  than  the  asylum.  These  opinions  had  been  urged 
so  persistently,  and  held  so  long,  that  they  had  become  a  hibit 
of  thought  which  was  deemed  by  some  to  have  the  authority  of 
a  law  of  nature.  Opinion  has  now,  however,  changed  so  much 
that  the  question  which  first  occurs  to  the  mind  is  whether  it 
is  possible  to  treat  the  patient  successfully  out  of  an  asylum. 
The  decision  as  to  what  should  be  done  is  often  most  difficult, 
since  social,  pecuniary,  and  legal  considerations  come  in  to 
complicate  the  medical  question,  and  most  medical  men  would 
williogly  be  rid  of  the  responsibility  which  it  entails.  At  one 
time,  perhaps,  they  find  the  friends  absolutely  refuse  to  adopt 
asylum-treatment  when,  in  their  judgment,  it  is  desirable  or 
urgently  necessary ;  at  another  time  they  find  them  urgent  to 
have  the  patient  removed  to  an  asylum,  and  as  eager,  if  he 
leaves  it  with  bitter  feelings  of  resentment  after  his  recovery,  to 
disclaim  all  responsibility  for  what  was  done,  and  to  throw  the 
blame  of  it  on  the  medical  adviser.  A  prudent  man,  having 
eased  his  conscience  by  the  candid  expression  of  his  opinion, 
will  scrupulously  avoid  officious  pressure,  and  decline  all  respon- 
sibility which  is  not  a  just  part  of  his  medical  function.  In  a 
great  many  cases  the  question  is  settled  at  once  by  the  pecu- 
niary means  of  the  person:  if  it  is  necessary  to  remove  him 
from  home,  he  must  go  to  an  asylum,  because  he  cannot  afford 
the  heavy  cost  of  treatment  in  a  private  house.  The  expenses 
of  a  suitable  house  or  lodgings,  of  skilled  attendance,  and  of 
medical  treatment,  amount  to  a  sum  which  those  only  who  are 
well  off  pecuniarily  would  be  justified  in  incurring  for  the 
length  of  time  that  might  be  necessary;  and  these  may  be 
obtained  in  an  asylum  at  one-third  the  cost  of  providing  them 
specially  for  himself.  Then  again  some  cases  are  manifestly 
unsuited  for  private  treatment.  If  the  patient  is  in  a  state  of 
furious  mania,  if  he  is  desperately  suicidal,  or  dangerous  to 
others  by  reason  of  delusions  which  are  likely  to  lead  him  into 
acts  of  violence,  if  he  persistently  refuses  food  and  requires  to 
be  fed  by  force,  if  he  is  impatient  of  restraint  and  violently 


62S  PATHOLOGY  OF  MIND.  [chap. 

rebels  against  it  or  shows  a  persistent  resolve  to  elude  it,  an 
asylum  is  the  fittest  place  for  him.  When  the  mental  derange- 
ment is  caused  by  epilepsy,  the  sullen  suspicions  and  blind  fury 
which  are  common  features  of  the  disease  render  it  unsafe  to 
keep  the  patient  at  home.  On  the  other  hand,  it  is  not  well  to 
send  a  young  person  who  is  suffering  from  mental  disorder  wliich 
is  of  a  hysterical  character,  or  occurs  in  connection  v/ith  puberty, 
or  is  the  result  of  self-abuse,  to  an  asylum ;  he  is  likely  to  be 
injured  by  the  surroundings  and  to  sink  to  their  level. 

In  choosing  an  asylum  it  w^ill  be  a  question  for  those  who 
are  able  to  pay  for  suitable  care  whether  it  should  be  a  public 
or  a  private  asylum.  Many  persons  entertain  an  easily  occurring 
and  deeply  rooted  suspicion  that  it  is  not  the  interest  of  a  pro- 
prietor of  a  private  asylum  to  cure  his  patients,  and  that,  there- 
fore, he  will  not  adopt  the  best  measures  to  cure  them.  But 
that  is  obviously  a  kind  of  suspicion  which  might  reach  very 
far  indeed  :  it  might  be  suspected  that  it  is  not  the  interest  of 
any  medical  man  to  cure  his  patient  quickly ;  not  the  interest 
of  a  lawyer  to  expedite  his  client's  business  ;  not  the  interest  of 
any  one  to  do  with  good  speed  what  will  bring  him  a  greater 
immediate  profit  if  he  makes  it  a  long  business.  The  asylum- 
proprietor,  like  other  people,  will  find  his  true  interest  in  the 
long  run  to  be  in  doing  best  the  service  which  he  professes  to 
do.  It  is  a  better  founded  objection  to  private  lunatic  asylums 
that  it  is  not  right  that  a  private  speculator  should  have  the 
power  w^hich  he  has  to  detain  in  confinement  persons  who  are 
deprived  of  their  liberty  against  their  wills,  albeit  for  their 
good.  The  principle  of  the  objection  is  thoroughly  sound  and 
cannot  be  gainsaid,  but  the  answer  to  the  particular  objection  is 
that  practically  the  proprietor  has  not  anything  like  the  power 
which  those  who  make  it  think  he  has.  The  stringent  legis- 
lative enactments  under  which  he  conducts  his  business,  the 
numerous  official  returns  which  he  is  compelled  to  make,  the 
minute  regulations  which  he  must  submit  to  on  pain  of  losing 
his  licence,  and  the  jealous  inspection  from  time  to  time  of  his 
house  by  the  Commissioners  in  Lunacy  and  by  the  magistrates, 
to  whom  each  patient  has  the  right  and  the  opportunity  to 
appeal,  reduces  an  authority  which  looks  despotic  to  a  mockeiy 


XI.]  THE  TREATMENT  OF  MENTAL  DISORDERS.  627 

of  power  that  is  essentially  more  like  slavery.  He  is  rather  in 
the  position  of  a  person  who  has  unlimited  responsibility  with 
very  limited  power. 

The  force  of  these  objections  put  aside,  it  may  be  admitted 
that  a  sensible  advantage  accrues  from  the  strong  personal 
interest  which  the  proprietor  of  an  asylum  has  in  its  good 
management  and  success :  when  his  livelihood  or  his  profit 
depends  upon  the  reputation  which  it  has  he  is  not  likely  to 
neglect  it.  His  business  is  to  please  his  patrons,  and  if  he 
fails  to  do  that  his  establishment  will  suffer.  A  well-managed 
private  asylum  is  sometimes  a  more  comfortable  residence 
than  a  public  asylum  for  the  same  reason  that  a  well-conducted 
proprietary  hotel  is  more  comfortable  than  a  large  joint-stock 
hotel  conducted  by  a  paid  manager — that  is  because  of  the 
strong  personal  interest  which  the  proprietor  has  in  it.  In 
a  public  asylum  everything  depends  upon  the  character,  the 
zeal,  and  the  skill  of  the  superintendent.  If  he  has  the  requisite 
qualities  for  his  post,  if  he  has  genuine  interest  in  his  work 
and  is  content  to  devote  himself  to  it  with  single-minded 
energy,  and  if  he  is  well  supported  by  a  body  of  intelligent 
governors,  then  there  will  be  good  management  and  efficient 
treatment ;  but  if  he  is  indifferent  or  negligent,  or  has  other 
interests  to  engage  him,  or  is  not  well  qualified  by  character 
and  attainments  for  his  onerous  and  anxious  post,  or  is  not  in 
harmony  with  his  governing  body,  then  abuses  soon  creep  in ; 
and  they  cause  a  vast  amount  of  suffering  in  a  large  establish- 
ment before  they  grow  to  such  a  pitch  as  to  attract  proper 
notice  from  a  body  of  governors  wdio,  having  only  a  corporate 
responsibility,  have  only  a  corporate  anxiety,  and  know  little 
about  the  real  working  of  the  establishment.  A  public  asylum 
must  have  fallen  into  a  very  bad  state  of  disorder  before  a  super- 
intendent is  actually  dismissed  for  incompetence,  and  during  the 
course  of  its  decline,  wdiile  servants  are  negligent  and  needful 
supervision  wanting  where  it  should  be  present  at  every  turn, 
the  patients  may  suffer  much  neglect  and  ill  treatment. 

The  discipline  of  a  large  asylum  certainly  counts  for  a  great 
deal  in  some  cases,  but  it  has  this  great  disadvantage — that  the 
patient's  individuality  is  little  thought  of ;  he  becomes  one  of  a 


528  rATIIOLOGY  OF  MIND.  [chap. 

crowd,  tlie  majority  of  whom  are  not  expected  to  recover,  and 
his  moral  treatment  is  little  more  than  the  routine  of  the  esta- 
blishment and  the  despotism  of  an  attendant.  In  pursuing  a 
proper  individual  treatment  of  insanity  it  is  necessary  to  pene- 
trate the  individual  character,  in  order  to  influence  it  benefici- 
ally by  moral  means,  and  to  investigate  carefully  the  concurrence 
of  conditions  which  have  issued  in  disease,  in  order  to  obviate 
them.  But  in  a  large  asylum  containing  two  or  three  hundred 
patients  or  more,  where  there  are  two  medical  men  who  go 
round  the  establishment  once  or  twice  a  day,  inspecting  the 
patients  generally  as  they  inspect  the  baths  and  the  beds  and 
exchanging  a  few  words  with  one  and  another  of  them,  they  are 
not  so  many  individuals,  each  having  a  particular  character  and 
a  particular  bodily  disposition  with  which  the  medical  officer  is 
intimately  acquainted,  but  so  many  residents  who  might  almost 
be  called,  as  the  residents  in  a  large  hotel  are,  by  numbers 
instead  of  names.  For  this  reason  it  is  sometimes  the  best 
treatment  to  remove  a  patient  from  an  asylum  to  the  care  of 
some  private  person  who  will  devote  himself  to  his  care  with 
a  strong  personal  interest ;  he  may  then  recover,  perhaps,  not- 
withstanding that  there  seemed  no  likelihood  of  his  recovery 
in  the  asylum. 

One  advantage,  however,  a  public  asylum  has,  which  is  un- 
doubtedly a  very  great  one :  it  is  that  the  patient  cannot  assert, 
nor  his  friends  suspect,  that  the  authorities  have  a  pecuniary 
interest  in  detaining  him.  That  puts  him  at  once  in  a  frame 
of  mind  more  favourable  to  treatment,  and  gives  the  phy- 
sician a  vantage  ground  of  independence  which  the  pro- 
prietor of  the  private  asylum  cannot  have.  Moreover,  the 
feeling  extends  through  the  whole  of  the  establishment  and 
aff'ects  its  general  tone;  attendants  experience  it  and  are  not 
so  much  tempted  to  intrigue  with  the  patient  or  meddlesome 
friends  against  the  wishes  of  its  head,  or — what  is  a  greater 
danger  in  private  asylums — conspire  with  the  proprietor  to  con- 
ceal any  wrong-doing,  and  to  hoodwink  the  friends  of  patients 
and  the  inspecting  authorities.  Some  patients  certainly  are 
influenced  beneficially  by  the  spirit  of  a  public  asylum  and 
conform  to  its  rules  who  would  resent  bitterly  or  actively  rebel 


XI. ]  THE  TKEATMENT  OF  MENTAL  DISORDERS.  529 

against  the  orders  of  a  private  proprietor,  whom  they  considered 
to  keep  them  in  confinement  for  their  own  profit.  No  one 
wlio  knows  the  difference  between  the  tone  of  feeling  in  a 
public  and  in  a  private  school  will  have  any  difficulty  in  appre- 
ciating what  I  mean. 

The  consequences  of  the  difficult  and  harassing  position  wdiich 
the  proprietor  of  a  private  asylum  occupies  are  not  beneficial  to 
his  character:  the  suspicions  to  which  he  is  liable  from  his 
patients  and  their  friends,  the  jealous  inspection  to  which  he  is 
subject,  the  rooted  popular  distrust  of  his  functions,  the  dreary 
and  thankless  nature  of  his  duties,  and  the  ever  urgent  sense  of 
responsibility  without  a  corresponding  sense  of  power,  have  a 
demoralising  effect  upon  him ;  and  he  runs  no  small  danger  of 
sinkin<T  into  a  state  of  mind  in  which  his  sole  aim  is  to  make 
large  profits,  looking  to  them  as  the  one  compensation  for  all 
the  humiliations  and  anxieties  which  he  has  to  undergo.  When 
the  treatment  of  an  insane  person  is  thus  considered  merely  as 
an  object  of  commercial  profit,  it  is  clear  that  matters  are  very 
wrong  and  that  grave  evils  must  ensue.  Moreover,  medical  men 
of  the  best  type  will  certainly  not  be  found  to  take  or  to  keep 
such  a  position :  a  fact  which  goes  far  to  be  a  practical  condem- 
nation of  private  asylums,  seeing  that  where  the  dangers  of  the 
position  are  such  as  to  require  the  highest  qualities  of  mind, 
these  will  never  be  obtained. 

It  is  hopeless  to  expect  such  perfection  of  arrangements 
either  in  public  or  private  asylums  as  will  get  rid  of  all  com- 
plaints, since  mental  disease  is  so  exceptional  in  the  trouble  and 
anxiety  which  it  occasions,  in  the  danger  which  it  sometimes 
involves,  and  in  the  conditions  of  treatment  w^hich  it  requires ; 
but  one  may  probably  look  forward  to  an  extension  of  the 
system  of  public  asylums  and  to  a  contraction  of  the  system  of 
private  asylums  according  as  social  feeling  with  respect  to  it 
becomes  healthier.  The  entire  abolition  of  the  latter  by  legisla- 
tion would  not  be  a  wise  measure  now,  nor  perhaps  at  any  time. 
Certainly  it  will  not  put  an  end  to  recurring  outbursts  of  clamour 
in  newspapers,  since  these  have  been  louder  in  America, 
where  the  public  asylum  system  is  in  vogue,  than  in  this 
country.    There  will  always  be  some  patients  moreover  who  are 


530  PATHOLOGY  OF  ]\IIND.  [chap. 

extremely  ill  fitted  to  face  the  life  of  a  public  asylum,  and  upon 
whom  the  associations  and  the  system  would  have  an  injurious 
effect ;  and  great  abuses  would  be  sure  to  ensue  if  there  were  no 
way  of  placing  any  recent  cases  of  mental  disorder  under  proper 
care  and  treatment  except  by  sending  the  sufferer  at  once  into 
a  public  asylum,  or  placing  him,  as  a  single  patient,  in  a  private 
house  under  the  care  of  attendants  and  unskilled  supervisors. 
Meanwhile,  in  making  choice  of  an  asylum  in  the  present  state 
of  things,  the  two  principal  considerations  to  be  had  in  mind  and 
duly  weighed  are — first,  the  character  of  the  patient  and  the 
form  which  his  malady  takes;  and  secondly,  the  reputation 
and  character  of  the  asylum.  It  would  be  foolish  to  carry  a 
prejudice  for  or  against  a  particular  system  so  far  as  to  reject 
what  was  the  best  measure  in  the  particular  circumstances.  If 
the  friends  of  a  patient  have  known  some  one  who  has  been 
treated  kindly  and  successfully  in  a  particular  private  asylum, 
they  will  do  well  to  act  upon  that  recommendation ;  if  they 
have  a  particular  public  asylum  strongly  recommended  to  them 
by  some  one  who  is  qualified  to  speak  confidently,  then  they 
will  do  well  to  be  guided  by  the  experienced  advice. 

When  it  is  not  actually  necessary  to  send  the  patient  to  an 
asylum,  it  is  still  often  necessary  to  remove  him  from  his  own 
home,  where  he  has  been  accustomed  to  exercise  authority  and 
to  exact  attention,  and  where,  in  his  much  changed  state,  there 
are  necessarily  ever-recurring  occasions  of  irritation  and  con- 
tention.    It  is  impossible  to  allow  a  madman  to  do  everything 
he  wishes,  by  yielding  submission  to  all  his  changing  fancies, 
delusive  projects,  and  perverted  feelings,  and  the  least  opposi- 
tion from  those  whose  compliance  he  looks  for  as  a  matter  of 
course,  is   likely  to  produce  an  outbreak  of  excitement.     If  he 
is  melancholic,  and  mistrusts  those  whom  he  most  loved  when 
he  was  himself,  or  grieves  that  he  has  lost  aU  his  affection  for 
them,  their  presence  is  a  constant  irritation  of  his  mental  sore  ; 
if  he  exacts  their  sympathy  by  continually  talking  about  his 
sufferings,   and  they  yield  it  in   full   measure,    his  disease  is 
really  fostered  thereby ;  if  he  has  delusions  that  he  is  ruined, 
he  is  driven  frantic  by  the  sight  of  the  necessary  expenditure. 
An   entire  chancre   of   surroundings    will  sometimes   of   itself 


XI.]  THE  TPtEATxMENT  OF  MENTAL  DISORDERS.  531 

initiate  recovery ;  it  takes  him  from  the  midst  of  the  cir- 
cumstances in  which  his  derangement  has  been  developed  and 
gets  rid  of  a  tliousand  occasions  of  irritation  and  of  aggrava- 
tion. Eelatives  endowed  with  a  similar  neurotic  temperament 
usually  constitute  the  worst  surroundings.  If  the  separation 
from  them  and  the  experience  of  his  new  surroundings  pro- 
duces a  mental  shock  and  is  a  real  grief,  that  will  be  no  great 
harm;  it  is  better  that  he  should  sorrow  with  a  real  cause 
of  sorrow  than  brood  continually  over  an  imaginary  grief; 
and  his  genuine  affliction  may  haply  become  the  initiation 
of  another  than  the  train  of  fixed  morbid  thoui2;ht.  It  is  com- 
mon  enough  to  hear  the  friends  of  a  person  whose  mind  is 
showing  plain  signs  of  disorder  declare  earnestly  that  they  are 
sure  it  would  drive  him  quite  mad,  so  sensitive  as  he  is,  to  send 
him  from  home  and  to  place  him  under  the  control  of  strangers, 
and  that  they  cannot  consent  to  it.  They  are  mistaken  for  the 
most  part ;  and  the  result  of  their  over-anxious  apprehensions 
and  their  reluctance  to  do  what  is  right,  but  painful  to  their 
feelings,  is  to  let  pass  the  important  opportunity  of  proper  treat- 
ment at  that  early  period  of  the  disease  when  there  is  always 
the  best  hope,  and  sometimes  the  only  hope,  of  effecting  a  cure. 
It  is  not  in  the  least  an  exaggeration  to  say  that  many  insane 
persons  have  owed  their  life-long  affliction  to  the  jealous 
sympathies,  without  knowledge,  of  those  to  whom  they  were 
most  dear. 

Travelling  from  place  to  place  with  a  suitable  companion  and 
attendant  may  be  justly  recommended  in  the  early  stages  of 
melancholic  derangement,  but  not  at  the  beginning  of  an  attack 
of  acute  mania.  Moreover,  the  travelling  should  certainly  not 
be  out  of  the  country  at  the  outset  of  any  form  of  decided 
mental  derangement ;  for  until  the  physician  can  form  a  fore- 
cast of  the  course  which  the  disease  is  likely  to  take — can 
satisfy  himself,  at  any  rate,  that  it  is  not  likely  to  become  acute 
— he  should  not  permit  the  patient  to  go  out  of  reach  of  the 
measures  that  may  be  required  urgently  for  his  safety  or  his 
proper  care.  Great  and  grievous  mistakes  are  sometimes  made 
in  this  respect  by  those  who  ought  to  know  better  than  advise 
a  person  to  be  sent  abroad  to  travel  who  is  sickening  for  an 


532  PATHOLOGY  OF  MIND.  [chap. 

acute  attack  of  insanity,  or  who,  not  knowing  better,  ought 
certainly  to  know  better  than  advise  at  all  concerning  what  they 
do  not  understand.  The  results  of  such  ignorant  mistakes  are 
sometimes  calamitous — an  attack  of  acute  mania  perhaps  in  a 
foreign  city,  where  those  in  charge,  ignorant  of  the  laws,  cus- 
toms, and  perhaps  language  of  the  country,  know  not  what  to 
do  or  where  to  turn  for  help,  and  are  put  to  the  greatest  straits 
and  to  the  most  cruel  anxieties ;  or  perhaps  an  act  of  suicide  on 
the  Alps,  which  appears  in  the  newspapers  as  an  accidental  death 
from  a  perilous  attempt  to  gather  the  Alpine  flower  edelweiss. 
When  an  attack  of  acute  insanity  has  passed  off  and  the  mental 
atmosphere  does  not  clear,  but  there  remains  some  disorder  of 
feeling  and  thought  which  raises  an  apprehension  that  the 
disease  will  become  chronic,  then  an  opportune  change  of  scene 
may  be  of  vital  importance  and  make  all  the  difference  between 
a  final  recovery  and  permanent  illness.  This  is  the  critical  time 
when  removal  from  an  asylum  is  sometimes  the  salvation  of 
reason.  Nay,  removal  only  from  one  asylum  to  another,  when 
the  patient  makes  no  progress,  but  appears  to  be  sinking  into  a 
chronic  groove,  has  sometimes  a  singularly  beneficial  effect.  It 
is  not  of  course  necessary  that  the  person  who  leaves  an  asylum 
be  sent  abroad ;  he  may  go  to  the  seaside,  or  take  a  walking 
tour  through  Scotland  or  Wales,  or  tramp  from  the  Land's  End 
to  Edinburgh  and  back.  Should  his  means  allow  it  he  may  go 
with  a  suitable  companion  and  efficient  attendant  to  Norway, 
or  to  America,  or  even  make  a  voyage  to  Australia.  I  have 
seen  good  results  from  all  these  measures  in  different  instances. 
Where  the  patient  is  not  fit  to  go  to  Australia  in  a  passenger- 
ship,  or  it  is  not  desirable  for  other  reasons  he  should  do  so,  I 
have  sent  him,  accompanied  by  a  medical  man  and  an  attendant, 
in  a  sailing  barque  which  took  no  other  passengers.  Although 
there  is  no  accommodation  for  passengers  in  such  a  vessel,  good 
arrangements  may  be  made  by  appropriating  the  captain's  cabin, 
which  he  will  give  up  for  a  suitable  consideration. 

There  are  some  cases  of  commencing  mental  derangement 
which  do  well  by  being  sent  to  a  hydropathic  establishment ; 
for  they  get  thus  entire  change  of  scene,  rest  from  work  which 
they  are  unfit  to  do,  some  kind  of  society,  regulated  diet  and 


XI.]  THE  TREATMENT  OF  MENTAL  DISORDERS.  533 

exercise  under  medical  supervision,  and,  if  needful,  the  benefit  or 
the  distraction  of  going  through  a  series  of  baths  daily.  Others 
who  are  too  unwell  for  that  treatment  may  be  sent  to  reside  in 
the  houses  of  medical  men,  many  of  whom  now  in  different 
parts  of  the  country  are  willing  to  receive  single  patients  into 
their  houses ;  there,  however,  they  must  be  properly  certified 
as  persons  of  unsound  mind,  and  all  the  statutory  regulations 
concerning  them  strictly  complied  with,  since  it  is  an  offence 
against  the  lunacy  laws  for  any  one  to  take  charge  of  an  insane 
person  for  profit  without  complying  with  those  regulations.  Care 
must  be  used  in  the  selection  of  a  proper  dwelling,  since  there 
are  unfortunately  not  a  few  persons  anxious  to  have  a  resident 
patient  whose  minds  are  more  set  upon  the  payment  which  they 
desire  to  get  than  upon  the  responsibility  which  they  incur  to  give 
habitual  attention  to  their  charge  and  to  endure  patiently  the 
burden  or  the  annoyance  which  he  is  apt  to  be  to  the  family. 
If  he  is  banished  to  a  room  of  his  own  and  left  all  day  to  the 
company  of  an  attendant,  he  would  be  better  off  in  a  well- 
conducted  asylum.  It  is  indeed  a  great  difficulty  to  ensure 
suitable  provision  and  skilful  treatment  in  a  private  house,  and 
the  physician  is  sometimes  driven  in  despair  of  having  things 
done  properly  to  recommend  the  patient's  removal  to  an  asylum, 
when  it  would  not  have  been  necessary  otherwise.  With  the 
proper  persons  about  the  patient  there  is  hardly  a  case  of 
insanity  which  might  not  be  treated  successfully  in  a  private 
house  ;  with  unfit  persons  about  him  the  simplest  case  becomes 
worse  and  worse.  An  asylum  is  proper  if  the  malady  is  of  such  a 
character  as  to  render  it  difficult  to  let  him  go  out  into  the  streets 
and  roads  and  so  have  the  regular  exercise  which  ought  to  be 
enforced.  There  are  some  patients  again  who  do  not  do  well  in 
private  houses  because  they  make  themselves  too  much  felt,  and 
themselves  feel  that  they  are  the  main  object  of  concern  in  all 
the  arrangements ;  their  perverted  morbid  feelings  experience 
gratification — unconsciously  to  themselves — in  the  commotion 
which  they  raise,  and  are  fostered  thereby,  and  they  wilfully 
display  caprices  that  gratify  their  morbid  seK- feeling  rather 
than  desire  or  attempt  to  restrain  them ;  they  are  likely  to  do 
far   better  in  an  asylum  where    they  are  units  in  a  number 


634  PATHOLOGY  OF  MIND.  [chap. 

and  parts  of  a  system,  where  their  morbid  moods  and  perverse 
doings  excite  not  much  notice  nor  any  alarm,  and  where  they 
feel  the  steadily  pressing  discipline  of  the  establishment  as  a  re- 
straint which  there  is  neither  gain  nor  gratification  in  rebelling 
against,  as  there  is  against  the  control  of  individuals. 

The  practice  which  w^as  so  common  at  one  time  of  placing 
insane  patients  in  cottages  under  the  control  of  attendants  is  to 
be  condemned  except  as  a  temporary  expedient :  persons  of  the 
class  of  attendants  in  the  charge  of  a  patient  should  be  under 
the  supervision  of  some  one  of  higher  social  position  who  may 
also  be  a  fit  companion  for  him.  Some  asylum- keepers,  quick 
to  make  profit  out  of  the  weaknesses  of  the  friends  of  patients 
who  evince  a  natural  anxiety  to  avoid  the  stigma  of  an  asylum, 
take  cottages  in  the  neighbourhood  of  their  asylum  or  on  the 
edge  of  its  grounds,  and  persuade  the  friends  that  the  patient 
will  have  in  one  of  them  the  advantage  of  their  constant  super- 
vision without  being  in  the  asylum.  The  truth  is  in  such  cases 
that  the  proprietor  sees  the  patient  once  or  twice  a-day  at  times 
when  the  attendants  know  w^ell  to  expect  the  visit,  and  that  for 
the  rest  of  the  day  he  may  be  grossly  neglected  or  ill  used,  or  if 
not  ill  used  actually,  he  is  left  to  an  enforced  and  unfit  associa- 
tion with  vulgar-minded  persons  who  talk  for  the  most  part  of 
betting,  horse-racing,  their  low  debaucheries,  and  the  like,  and 
who  in  the  worst  cases  convert  the  place  into  a  brothel.  No 
friends  should  consent  to  have  their  relative  placed  in  a  cottage 
of  this  sort  who  is  not  so  well  as  to  be  able  to  take  care  of  and 
amuse  himself,  unless  there  is  a  lady  or  gentleman  living  in  the 
house  whose  duty  it  is  to  superintend  the  attendants  and  to 
associate  with  the  patient.  And  it  would  not  be  amiss  if  tlie 
Commissioners  in  Lunacy  were  to  bestow  some  pains  to  inquire 
closely  into  the  particulars  of  the  actual  life  from  morning  to 
night  of  the  patient  who  is  placed  in  a  cottage  of  this  kind  and, 
if  need  be,  to  make  strong  representations  to  the  friends,  who 
are  perhaps  being  grossly  duped  by  the  advantage  taken  of  an 
amiable  sentiment. 

It  is  unquestionably  of  the  first  importance  that  early  treat- 
ment should  be  adopted  in  any  case  of  insanity,  as  the  pro- 
bability  of    recovery   is   immensely  increased   thereby.      The 


X1.1  THE  TREATMENT  OF  MENTAL  DISORDERS.  535 

statistics  of  all  asylums  are  at  one  in  proving  that  the  more 
recent  the  outbreak  the  better  is  the  cliance  of  recovery;  the 
expectation  whereof  indeed  is  about  four  to  one  when  efficient 
treatment  has  been  put  in  force  within  three  months  from  the 
commencement  of  the  disease,  but  hardly  as  much  as  one  to 
four  when  it  has  lasted  twelve  months.  Were  the  first  obscure 
threatenings  of  mental  disease  duly  appreciated  and  right  action 
promptly  taken,  there  is  reason  to  think  that  many  cases  might 
be  cut  short  at  the  outset;  but  the  difficulty  is  to  bring  the 
patient  and  his  friends  to  recognise  the  gravity  of  the  crisis,  or, 
if  they  are  brought  to  see  it,  to  induce  him  to  submit  to  what  is 
necessary.  The  consequence  is  that  the  disease  goes  on  until 
the  habit  of  a  definite  morbid  action  is  fixed  in  the  mental 
organisation,  which  cannot  then  be  eradicated  quickly  by 
vigorous  and  energetic  measures  of  any  kind,  but  must  be 
undermined  slowly  by  a  patient  course  of  systematic  treatment. 
And  this  also  should  be  borne  in  mind,  in  order  to  check  feel- 
ings of  undue  impatience,  that  the  natural  duration  of  mental 
disease  is  much  longer  than  that  of  most  other  diseases :  where 
in  them  time  is  counted  by  hours  and  days,  it  must  be  counted 
in  it  by  weeks  and  months. 

Furthermore  it  must  be  confessed  that  recovery  after  mental 
disease  is  not  worth  so  much  as  recovery  after  some  other  diseases, 
since  there  is  considerable  risk  of  a  relapse  at  some  time  or  other. 
On  this  subject  we  can  have  no  more  weighty  authority  than  the 
late  Dr.  Thui^nam,  who  came  to  the  broad  conclusion  that  while  a 
proportion  of  40  per  cent,  of  recoveries,  calculated  on  the  yearly 
admissions  into  asylums,  was  to  be  regarded  as  low,  and  a  pro- 
portion exceeding  45  per  cent,  as  high,  the  liability  to  a  recurrence 
of  the  disease  after  recovery  from  a  first  attack  could  not  be  esti- 
mated at  less  than  50  per  cent.,  or  as  one  in  two  cases  discharged 
recovered.  On  the  whole  then  it  may  be  said  that  of  ten  persons 
who  fall  insane  five  recover,  and  five  die  sooner  or  later  without 
recovering.  Of  the  five  who  recover  not  more  than  two  remain 
well  for  the  rest  of  their  lives  ;  the  others  have  subsequent  attacks, 
after  long  intervals  of  sanity  it  may  be,  during  which  at  least 
two  of  them  die.  The  apprehension  then  which  is  commonly 
shown  of  persons  who  have  once  been  insane,  as  if  they  might 


536  PATHOLOGY  OF  MIND.  [chap. 

at  any  moment  relapse  into  their  malady,  is  in  some  measure 
just.  In  the  first  place,  the  susceptibilities  and  peculiarities  of 
character  which  issued  in  the  first  attack  remain  the  same — 
the  personality  is  unchanged ;  and,  in  the  second  place,  there  is 
in  addition  the  acquired  aptitude  which  has  been  left  behind  by 
the  previous  derangement. 

When  putting  in  force  measures  to  place  an  insane  person 
under  restraint  it  is  desirable  to  avoid  practising  deception,  if  it 
be  possible  :  what  is  done  should  be  done  openly,  and  explained 
and  enforced  as  necessary  and  unavoidable.  It  is  certainly  most 
objectionable  to  entrap  him  into  an  asylum  on  some  pretext 
which  he  discovers  to  be  false  so  soon  as  he  gets  there ;  but  it  is 
stiU  worse  to  employ  fraud  to  get  the  medical  certificates,  as 
asylum-keepers  often  did  in  times  past  and  some  do  still,  and 
then  to  leave  him  to  be  removed  to  the  asylum  by  attendants 
without  ever  explaining  to  him  what  his  position  is  and  what  is 
to  be  done  with  him.  Insane  persons  frequently  turn  out  to  be 
much  more  amenable  to  reason  than  might  be  expected  when 
they  are  approached  openly  and  dealt  with  frankly  and  in  a 
straightforward  manner.  But  when  they  are  grossly  deceived 
the  natural  suspicion  of  the  disease  is  strengthened;  they 
cannot  have  that  confidence  in  those  who  have  been  parties  to 
the  fraud  which  they  ought  to  have  if  a  good  moral  influence  is 
to  be  exercised  upon  them,  and  they  are  likely  to  cherish  a  bitter 
feeling  of  resentment  afterwards. 

Suitable  conditions  of  treatment  having  been  arranged,  the 
aim  must  be  to  turn  the  patient  from  the  absorption  of  his 
self-brooding  or  his  self-exaltation  to  wholesome  relations  with 
matters  outside  himself — to  engage  him  by  degrees  in  some  work 
or  interest,  it  matters  not  however  trivial  at  first,  which  shall 
take  his  attention  from  his  morbid  self.  If  he  is  induced  to  do 
like  other  people,  he  will  be  helped  in  the  best  way  to  feel  and 
think  like  them.  The  great  principle  to  be  acted  upon  in  order 
to  recover  from  insanity  is  that  which  should  be  acted  upon  by 
a  person  in  order  to  prevent  himself  from  becoming  insane — 
namely,  not  to  distinguish  himself  from  other  persons  as  in  any 
respect  extraordinary  nor  to  dissociate  himself  from  their  in- 
terests and  doings.     Now  it  is  really  more  easy  for  an  insane 


XI.]  THE  TREATMENT  OF  MENTAL  DISORDERS.  537 

persou  to  do  some  simple  work  or  to  foster  some  simple  interest 
when  the  surroundings  have  been  entirely  changed  than  when 
he  is  solicited  to  do  so  in  the  midst  of  the  surroundings  and 
interests  of  his  former  life,  since  it  seems  to  him  almost  a 
mockery  to  press  him  to  do  trifles  when  he  is  in  face  of  real 
duties  to  which  he  is  unequal,  and  when  perhaps  a  great  part  of 
his  avowed  distress  is  because  he  cannot  perform  them.  The 
success  of  attempts  to  engage  his  attention  on  matters  outside 
himself  will  depend  greatly  upon  the  knowledge,  tact,  and 
patience  of  those  who  make  them.  Good  and  kindly  feeling 
and  natural  tact  require  to  be  supplemented  by  some  special 
experience.  Those  who  in  an  eager  anxiety  to  encourage  the 
patient  make  much  of  his  initiatory  and  perhaps  half-ashamed 
attempts  and  call  attention  to  them  ostentatiously,  instead  of 
accepting  them  tacitly  and  making  them  the  steps  of  a  further 
advance,  drive  him  back  into  his  morbid  self  and  cause  him  to 
abandon  them.  If  it  can  be  brought  about,  steady  employment 
will  do  more  than  anything  else  to  promote  recovery :  for  the 
insane,  as  for  the  sane,  action  is  the  best  cure  of  suffering.  The 
natural  apprehensions  of  harm  to  the  patient  from  the  depress- 
ing influences  of  association  in  an  asylum  with  other  persons 
similarly  afflicted  are  generally  exaggerated ;  in  his  changed 
state  he  will  more  easily  begin  to  do  something  among  those 
whose  condition  he  recognises  as  no  better  or  as  worse  than  his 
own  than  among  those  whom  he  has  been  accustomed  to 
meet  when  he  was  so  different  from  what  he  now  feels  himself  to 
be.  When  he  can  be  brought  to  take  some  intelligent  notice  of 
them,  if  it  be  only  to  combat  the  opinions  of  another  patient, 
and  to  think  less  of  himself,  he  has  made  the  first  step  towards 
recovery.  Strange  as  it  may  seem,  insane  surroundings  are 
sometimes  a  positive  relief  and  benefit  to  the  deranged  mind. 

"When  there  is  a  fixed  delusion  in  the  mind  it  is  not  of  the 
least  use  to  argue  against  it,  for  it  will  not  be  uprooted  by  the 
most  logical  reasoning ;  on  the  contrary,  it  will  be  likely  to  hold 
the  firmer  the  more  it  is  directly  combatted.  By  engaging  the 
mind  in  other  thoughts  as  much  as  possible,  and  so  substituting 
a  healthy  energy  for  the  morbid  energy,  the  force  of  the  delusion 
will  abate  by  degrees  and  finally  die  out.     Besides,  by  denying 


538  PATHOLOGY  OF  MIND.  [chap. 

bluntly  tlie  reality  of  what  seems  so  very  real  to  the  patient,  one 
hurts  his  self-love  and  ano-ers  him,  and  he  loses  that  confidence  in 
one's  good  feeling  which  it  is  most  important  he  should  have. 
Por  this  reason  also  it  is  a  mistake  to  treat  his  delusions  with 
contemptuous    ridicule.      But,    although   it    is   vain   to  argue 
against  a  delusion,  it  is  proper  to  avoid  assent  to  it :  by  a  calm 
expression  of  dissent,  or  by  a  quiet  show  of  incredulity,  or  by 
a  little  good-tempered  banter,  the  patient  should  be  left  under 
no  mistake  as  to  the  opinion  which  other  people  have  of  it.     A 
word  of  contradiction  in  season  will  sometimes   have  a  good 
effect  of  shaking  his  confidence  in  his  delusion,  or  at  any  rate  of 
making  him  ashamed  to  talk  of  it,  which  is  the  first  step  to- 
w^ards   feeling   a   doubt  of  it.     Baillarger  tells  a   story  which 
shows  well  how  little  force  proof  has  against  an  insane  delusion. 
When  M.  Tr^lat  was  intrusted  provisionally  wdth  the  manage- 
ment of  the  Bicetre,  he  had  under  his  charge  a  patient  who 
believed   that   he    had   discovered   perpetual    motion.       After 
having  argued  vainly  against  the  delusion,  the  idea  occurred  to 
Trelat  that  perhaps  the  great  authority  of  Arago  would  have 
the  good  effect  of  convincing  the  patient  of  his  error.     Arago, 
after  having  had  the  assurance  given  him  that  insanity  was  not 
a  contagious  malady,  consented  to  combat  the  delusion  of  the 
lunatic,  who  was  accordingly  introduced  into  his  study  when 
Humboldt  happened  to  be  paying  him  a  visit.     Hardly  had  the 
patient  heard  from  Arago  the  firm  and  convincing  disproof  of 
his  error  than  he  ^vas  confounded  and  shed  teai^,  deploring  the 
loss  of  his  illusion.     The  desired  end  seemed  to  be  attained,  but 
tliey  had  not  gone  more  than  twenty  paces  from  the  observatory 
on  their  return  when  the  patient,  addressing  Trelat,  said,  "  It  is 
all  one ;  M.  Arago  deceives  himself ;  I  am  in  the  right."     It  is 
common  enough  for  the  friends  of  an  insane  patient  who  labours 
under  the  delusion  that  he  is  doomed  to  eternal  damnation  to 
employ  the  services  of  a  clergyman  in  order  to  dissipate  it  by 
argument,  and  in  one  case  which  came  under  my  care  the  aid 
of  an  eminent  bishop  had  been  invoked  in  vain.     Those  who 
fondly  hope  to  overthrow  an  insane  delusion  by  argument  would 
do  well  to  consider  how^  little  the  most  illogical  convictions  of 
sane  persons  are  touched  by  the  plainest  demonstration  of  their 


XI.]  THE  TREATMENT  OF  MENTAL  DISORDERS.  559 

unsoundness,  and  how  easy  some  of  tliem  find  it  to  hold 
contentedly  side  by  side  in  their  minds  two  logically 
incompatible  opinions.  They  do  not  sincerely  believe  that 
Jonah  was  swallowed  by  a  whale  and  lived  three  days  and 
nights  in  its  inside,  but  they  would  be  dreadfully  shocked  if 
they  were  charged  with  doubting  the  truth  of  the  miracle. 
They  admit,  when  pressed  with  quiet  argument,  that  the  leaders 
of  their  political  party  have  done  everything  which  they  should 
not  have  done  and  left  undone  everything  which  they  should 
have  done  in  a  gTeat  crisis,  and  at  the  same  time  when  they  get 
amongst  their  kind  they  shout  and  yell  in  sincere  and  exulting 
admiration  of  the  profound  statesmanship  sliown  on  that  and 
all  occasions  by  these  same  leaders. 

Beliefs  rest  for  the  most  part  on  foundations  which  arguments 
cannot  reach — on  feelings,  habits,  prejudices,  the  bias  of  interests 
and  of  wishes  and  of  fears,  and  they  change  without  reason 
when  the  substratum  of  feeling  in  which  they  are  rooted 
changes.  All  history  shows  that  revolutions  of  popular  belief 
have  not  taken  place  gradually  in  consequence  of  the  assaults  of 
reason,  but  suddenly  from  no  immediate  help  of  reason,  in  con- 
sequence of  a  certain  change  of  sentiment  that  has  been  insen- 
sibly brought  about :  the  multitude  which  is  shouting  acclam- 
mations  at  its  hero  one  day  is  howling  execrations  at  him  on 
another  day,  and  could  give  no  intelligent  reason  either  for  its 
adoration  or  its  hatred,  or  for  the  change  from  the  one  to  the 
other.  The  effect  of  mental  infection,  when  enthusiasm  is 
inflamed,  is  to  cause  multitudes  to  think  and  howl  together,  as 
jackals  hunt,  in  packs.  It  is  as  with  the  s]3read  of  a  conflagra- 
tion; the  heat  of  the  burning  part  raises  the  adjacent  parts  to 
a  temperature  at  which  they  easily  catch  fire,  and  so  one  earnest 
fool  makes  many  fools. 

The  way  to  get  rid  of  an  insane  delusion  is  to  change  the 
feeling  in  which  it  is  rooted — to  disarm  his  suspicion  if  the 
patient  is  suspicious,  to  raise  his  spirits  if  he  is  depressed,  to 
appease  his  anger  if  he  is  offended,  to  abate  his  conceit  if  he  is 
proudly  exalted  ;  in  that  way  the  particular  delusion  is  deprived 
of  the  sap  which  nourishes  it.  It  is  of  the  greatest  importance, 
therefore,  to   have    about  him  persons  whose  dispositions  and 


to 


540  PATHOLOGY  OF  MIND.  [chap. 

dealings  with  him  are  adapted  to  attract  his  confidence,  and  to 
avoid  the  irritation,  the  collisions,  and  the  aggravation  of  the 
disease   which   are   produced   by   uncongenial   attendance.      A 
female  nurse  will  sometimes  do  more  with  a  male  patient  than 
the  best  male   attendant;    he  will  not  resist  her  violently  as 
he  would  a  man,  and  will  perhaps  yield  to  her  persuasion  more 
readily  and  with  less  feeling  of  humiliation.      Certainly  a  good 
deal  more  use  might  be  discreetly  made  of  women  as  nurses 
of  male  insane  patients  than  is  done  at  present.     As  regards 
attendants  generally  it  is  certain  that  a  patient  will  sometimes 
begin  to  improve  immediately  under  the  care  of  one  person  when 
he  or  she  has  been  getting  worse  and  worse  under  the  care  of 
another.      Here,  indeed,   lies  the  real   difficulty  in  the  treat- 
ment  of  insanity — namely,   to   obtain   as   attendants   persons 
who   are   fitted    for    so    anxious,   trying,    and   responsible    an 
employment.      It  is  not  a  question  of  money  only,  for  money 
^      cannot  buy   the   gentleness,   the   firmness,  the  patience  under 
infinite  irritation,  the  willingness  to  do    without   sign   of   re- 
luctance or  disgust  the   most  disagreeable   offices,   the  self-re- 
straint that  is  almost  more  than  human,  which  are  the  ideal 
qualities   of  a   good  attendant.      The  easy  recommendation  to 
obtain  for  the  work  the  services  of  persons  of  a  superior  class 
to  that  from  which  attendants  are  usually  procured,  by  making 
higher  payments,  is  liable  to  the  objection  that  superior  persons 
who  have  not  failed  in  more  congenial  positions  from  faults  of 
character  will  not  undertake  the  anxious,  dreary,  and  disagree- 
able work.      Still  it  is  probable  that  great  improvement  might 
be  made  in  the  management  of  asylums  by  appointing  several 
persons  of  a  higher  class  as  superintendents  over  the  ordinary 
attendants,  wdiose  duty  it  would  be  to  live  amongst  the  patients 
as  attendants  do.     Meanwhile  there  is  clearly  a  great  work  for 
brethren  of  the  cross  and  sisters  of  mercy  who  wish  to  live  lives 
of  the  most  self-sacrificing  devotion.      If  there  be  a  danger  of 
these  people  showing  an  indiscreet  religious  zeal  and  doing  harm 
thereby,  let  those  who  are  fired  by  the  enthusiasm  of  humanity 
institute  a  brotherhood  of  humanity  which  shall  show  to  the 
world  of  what  self-sacrifice  men  are  capable  who  are  inspired  only 
by  a  simple  love  of  their  kind  and  a  desire  to  do  it  good.     They 


XL]  THE  TREATMENT  OF  MENTAL  DISORDERS.  541 

may  expect  to  do  more  in  that  practical  way  to  propagate  the 
religion  of  humanity  which  they  profess  than  by  any  number 
of  meetings  together  to  worship  the  Great  Being  of  Humanity, 
or  by  multitudes  of  impassioned  articles  in  magazines. 

Medical  Treatment. 

The  special  medical  treatment  of  mental  disease  lies  within  a 
small  compass.  No  physic  in  the  world  can  touch  an  insane 
vanity  or  suspicion,  or  pluck  from  the  memory  a  rooted  sorrow, 
or  raze  out  the  written  troubles  of  the  brain.  If  that  is  to  be 
done,  it  must  be  done  by  the  gradual  operation  of  sound  moral 
hygiene  and  the  healing  effects  of  time.  We  must  be  content 
to  recognise  the  fact  that  in  a  great  many  cases  it  wdll  not  be 
done  ;  and  that  we  may  do  without  feeling  that  medical  art  is 
thereby  reproached  wdth  a  culpable  incompetence.  There  are 
some  persons  who  have  been  begotten  and  conceived  in  an 
insane  spirit,  bred  in  an  insane  moral  atmosphere,  and  have 
thought,  felt,  and  acted  in  an  insane  way  all  their  lives ;  these 
people  will  remain  lunatics  as  long  as  they  live,  will  die 
lunatics,  and,  unless  they  have  been  made  new  creatures  mean- 
while, will  rise  lunatic  spirits  at  the  day  of  judgment. 

In  determining  what  medical  treatment  to  use  in  a  particular 
case  the  important  thing  is  to  look  to  the  general  bodily  con- 
dition of  the  patie;it,  and  to  treat  that,  if  it  needs  treatment — 
to  do  in  fact  exactly  what  would  be  done  were  there  no  mental 
malady.  If  the  person  be  gross  and  overfed,  the  physician  must 
prescribe  active  exercise  and  moderate  and  clean  living ;  if  he 
be  of  a  gouty  diathesis,  he  must  attack  the  latent  gout;  if 
epileptic,  the  epilepsy ;  if  phthisical,  the  phthisis ;  if  syphilitic, 
the  syphilis ;  if  anaemic,  the  iron-wanting  blood.  Tliere  will 
be  a  better  hope  of  doing  good  to  the  mental  disorder  w-hen  he 
can  lay  hold  of  some  positive  constitutional  disorder  to  work 
upon,  than  when  he  finds  no  fault  in  the  bodily  health.  Let 
him  first  take  heed  then  to  the  removal  of  those  bodily  con- 
ditions which  appear  to  have  acted  as  causes,  partial  or  entire, 
of  the  mental  derangement,  and  to  the  general  improvement  of 
nutrition.     That  being  his  first  duty,  it  is  plain  that  no  one  is 


542  PATHOLOGY  OF  MIND.  [diAP. 

fitted  to  practise  as  a  specialist  in  mental  diseases  who  has  not 
a  sound  knowledge  of  disease  generally. 

It  will  be  proper  next  to  inquire  closely  concerning  any  mor- 
bid sensations  which  may  be  felt  in  one  part  or  another  of  the 
body ;  oftentimes  these  spring  from  some  real  bodily  disorder 
and  help  to  sustain  the  delusion  or  other  derangement  of  mind ; 
wherefore  the  removal  of  their  cause  may  do  good  to  the  mind. 
Bodily  disease  is  not  easily  detected,  and  is  apt  to  be  overlooked 
in  the  insane,  since  they,  like  animals,  make  no  complaint  in 
many  instances,  and  the  usual  symptoms  are  masked  by  the 
mental  malady ;  wherefore  it  is  necessary  to  pay  particular 
attention  to  all  physical  signs  of  disease.  Phthisis,  for  example, 
wiU  probably  be  discovered  in  that  way  only,  since  there  may  be 
no  cough,  no  expectoration,  even  when  it  is  far  advanced ;  and 
there  is  no  doubt  that  many  cases  of  unrecognised  phthisis  are 
received  into  asylums.  If  we  bear  well  in  mind  the  various 
modes  of  the  pathological  causation  of  insanity  which  were  pre- 
viously set  forth,  we  shall  perceive  the  necessity  of  making  a 
careful  and  exact  examination  of  the  entire  bodily  functions  in 
every  case,  and  of  applying  our  medical  measures  to  put  right 
what  is  wrong  in  them.  To  go  through  an  examination  of  the 
possible  bodily  derangements  would  be  to  recapitulate  what  has 
been  already  said. 

Going  on  then  to  the  discussion  of  particular  means  of  treat- 
ment, I  shall  say  a  few  w^ords  about  general  blood-letting,  which 
was  at  one  time  a  fashionable  measure  in  the  treatment  of 
mental  as  of  other  disease.  It  is  not  used  now  even  in  the 
most  acute  and  seemingly  sthenic  forms  of  insanity.  The  con- 
viction is  that  it  is  not  merely  useless,  but  positively  pernicious : 
convulsion  of  mind  is  not  strength  of  mind,  and  is  not  to  be 
radically  benefited  by  draining  off  the  life  that  is  in  the  blood  ; 
for  although  violent  symptoms  may  be  lessened  temporarily  by 
blood-letting,  they  soon  return  and  call  as  loudly  again  for 
blood-letting,  and  with  each  loss  of  blood  the  risk  is  increased 
of  the  disease  becoming  chronic  and  ending  in  permanent  de- 
mentia. A  local  abstraction  of  blood  by  means  of  leeches  to 
the  temples  or  of  cupping  on  the  back  of  the  neck  is  not  open 
to  the  same  objection ;  it  should  not  be  done,  if  it  is  done,  with 


XL]  THE  TREATMENT  OF  MENTAL  DISORDERS.  543 

the  object  of  abating  the  excitement  by  lowering  the  general 
strength,  but  in  order  to  withdraw  blood  from  the  overfull 
vessels,  and  of  so  yielding  relief  and  rest  to  the  suffering  nerve- 
element.  If  that  can  be  accomplished  one  may  consider  that 
it  is  to  follow  in  the  path  of  nature,  which  lessens  the  quantity 
of  the  blood  in  the  brain  during  sleep.  Practically,  however, 
local  blood-letting  in  insanity  is  but  little  more  used  nowadays 
than  general  blood-letting. 

Baths  of  different  kinds  have  been  more  largely  used  abroad 
in  the  treatment  of  insanity  than  in  this  country,  where,  on  the 
whole,  their  value  is  not  sufficiently  appreciated.  A  prolonged 
warm  bath  w^ill  sometimes  do  more  to  allay  excitement  and  to 
procure  beneficial  sleep  in  acute  insanity  than  any  narcotic;  and 
its  good  effect  will  be  increased  by  the  application  of  cold  to  the 
head  while  the  patient  lies  in  it,  either  by  means  of  a  douche- 
pipe,  or  by  watering  the  head  from  a  hand  shower-bath  or  a 
common  garden  w^atering-can,  or  by  sponging  the  head  and  face 
with  cold  water.  There  can  be  no  doubt  of  the  good  effects  of 
a  tepid  bath  to  allay  cerebral  excitement.  Our  knowledge  of 
the  sympathy  of  organs  has  taught  us  how  w^e  can  produce 
indirectly  a  change  in  the  state  of  one  organ  which  is  directly 
inaccessible  to  us  by  producing  an  appropriate  change  in  another 
which  is  directly  accessible  to  us ;  and  we  may  operate  in  this 
way  upon  the  brain  by  means  of  baths,  either  to  exalt  indirectly 
its  activity,  as  when  w^e  stimulate  the  peripheral  nerves  by 
cold  baths  and  vigorous  friction  of  the  skin,  or  to  lessen  irri- 
tation of  it,  by  the  soothing  and  relaxing  application  of  tepid 
baths  to  the  consensual  skin.  Such  a  simple  measure  as  spong- 
ing the  forehead  and  face  with  cold  water,  especially  if  it  be 
accompanied  by  the  soothing  words  of  a  congenial  attendant, 
will  sometimes  produce  an  effect  which  seems  out  of  all  proj3or- 
tion  to  its  simplicity.  The  warm  bath  may  be  continued  for 
half  an  hour,  or  even  longer,  but  its  effect  should  be  watched ; 
and  its  prolonged  use  is  to  be  avoided  where  the  pulse  is  very 
feeble  and  where  there  is  anything  like  commencing  paralysis. 
In  France  it  has  been  used  for  eight  or  ten  hours  at  a  time,  and, 
it  is  said,  with  good  results ;  and  Leidesdorf,  of  Vienna,  has 
used  for  three  or  four  hours  at  a  time,  with  marked  tranquil- 

24 


5i4  PATHOLOGY  OF  MIND.  [chap. 

lisiiig  effect,  a  bath,  constructed  by  Hebra,  in  which  patients 
can  be  kept  night  and  day  at  a  definite  temperature.  The  cold 
bath  has  also  been  used  abroad  for  long  periods  at  a  time. 
Professor  Albers  published  the  notes  of  some  cases  of  excited 
melancholia,  with  dirty  habits,  destructive  tendencies,  and  sleep- 
lessness, in  which  much  good  was  done  by  a  prolonged  use  of 
the  cold  bath.  The  patients  were  placed  for  one  or  two  hours, 
according  to  circumstances,  in  water  of  the  temperature  of  54° 
Fahr. ;  the  effect  was  to  lower  the  temperature  of  the  body 
several  degrees,  to  bring  down  the  pulse  until  it  was  scarcely 
perceptible,  to  subdue  excitement,  and  to  procure  some  hours 
of  sleep  when  they  were  afterwards  put  to  bed.  This  is  a 
dangerous  practice,  which  cannot  be  recommended;  the  risks 
of  it  are  out  of  all  proportion  to  the  good  which  is  ever 
obtained ;  and  some  cases  have  been  recorded  in  which  such  a 
prolonged  use  of  the  cold  bath  undoubtedly  produced  the  tran- 
quillity of  death. 

The  regular  use  of  the  cold  shower-bath  for  half  a  minute  or 
a  minute  at  a  time,  with  subsequent  brisk  rubbing  of  the  skin, 
is  to  be  commended  in  the  melancholia  of  young  and  vigorous 
subjects,  in  whom  reaction  takes  place  fully  afterwards,  but  it 
should  be  avoided  in  aged  persons  and  in  those  who  have  a 
feeble  circulation  or  show  any  symptoms  of  paralysis.  In  acute 
mania,  where  there  is  a  great  deal  of  noisy  excitement  and 
turbulent  energy,  the  shower-bath  is  sometimes  used  systemati- 
cally with  advantage ;  and  in  these  cases  it  may  be  given  for 
a  longer  period  than  in  melancholia — that  is  to  say,  for  one  or 
two  minutes,  but  never  for  more  than  three  minutes  at  a  time. 
Some  writers  recommend  its  employment  as  decidedly  bene- 
ficial in  cases  in  which,  after  the  acute  symptoms  of  mental 
disease  have  subsided,  the  patient  seems  to  be  about  to  lapse 
into  depression  or  dementia  instead  of  going  on  gradually  to 
recovery.  It  is  a  remedy  which  is  always  more  fitted  for  use  in 
young  persons  than  in  those  who  are  advancing  in  age  or  are 
aged. 

The  Turkish  bath  has  been  extravagantly  praised  by  some  of 
those  who  have  employed  it  in  the  treatment  of  mental  disease. 
It  is  affirmed  to  be  particularly  useful  in  cases  of  melancholia. 


XI.]  THE  TREATMENT  OF  MENTAL  DISORDERS.  545 

I  am  unable  to  speak  of  its  merits  from  personal  experience, 
but  can  well  believe  that  the  occasional  but  not  too  frequent 
use  of  it,  with  its  elaborate  shampooing  of  the  body,  might  be 
of  service  in  some  cases  of  mania  and  melancholia  in  which  the 
skin  is  dry  and  harsh  and  its  secretion  disordered. 

Packing  in  the  wet  sheet  after  the  hydropathic  fashion  was 
strongly  recommended,  and  largely  employed,  by  Dr.  Lockhart 
Eobertson,  formerly  superintendent  of  the  Sussex  County  Asy- 
lum. Without  doubt  it  is  a  valuable  measure  in  some  cases  of 
acute  excitement.  The  wet  sheet  has  an  indirect  soothing  action 
upon  the  brain  by  its  direct  soothing  action  upon  the  skin,  so 
that  the  patient  goes  to  sleep  in  it  sometimes  when  nothing  more 
is  done;  moreover,  by  keeping  a  restless  and  excited  person 
perforce  quiet,  it  assists  a  sedative  draught  to  take  effect  which 
would  have  been  useless  had  he  been  running  about  the  room. 
On  one  occasion  I  w^as  called  in  haste  to  see  a  young  woman 
who  had  been  attacked  suddenly  with  acute  hysterical  mania,  to 
the  great  consternation  of  the  household  and  to  the  despair  of  her 
medical  attendant,  who  could  not  induce  her  to  swallow  anything. 
She  had  torn  her  nightdress  into  shreds,  was  quite  incoherent,  and 
was  tossing  about  on  her  bed  ceaselessly.  She  was  immediately 
packed  in  the  wet  sheet,  her  face  bathed  with  cold  water,  and  a 
cloth  dipped  in  cold  water  applied  to  the  head ;  when  this  had  been 
done  she  swallowed  without  difficulty  a  drachm  of  the  tincture 
of  henbane,  and  soon  went  to  sleep.  In  the  morning  she  was 
free  from  excitement  but  confused  in  mind,  and  in  a  few  days  had 
quite  recovered.  On  another  occasion  I  was  summoned  into  the 
country  to  see  a  lady  who  was  labouring  under  acute  puerperal 
mania.  The  excitement  had  steadily  increased  for  some  days, 
and  she  had  not  slept  despite  many  sedative  doses.  I  found  her 
in  bed,  excited  and  utterly  incoherent,  with  one  leg  tied  to  each 
bedpost,  and  with  her  body  also  tied  down  to  the  bed.  Her 
lips  and  tongue  were  dry,  her  voice  was  hoarse  with  shouting, 
and  she  refused  all  food  and  drink  which  was  put  to  her  lips. 
She  was  straightway  released  from  her  bonds  and  packed  in 
the  wet  sheet,  her  face  and  forehead  and  mouth  being  sponged 
gently  with  cold  water.  After  a  while  a  mixture  of  milk  and 
soda-water  was  put  to  her  lips,  which  she  drank  rather  greedily. 


546  PATHOLOGY  OF  MIND.  [chap. 

and  then  a  dose  of  the  tincture  of  henbane  was  given.  She  fel) 
asleep,  began  to  mend  from  that  time,  and  in  three  week.-' 
was  restored  to  health.  These  examples  of  exceptionally  suc- 
cessful results  serve  to  show  the  value  of  the  wet-pack,  for 
there  is  no  doubt  that  the  good  was  done  by  it  and  not  by  the 
henbane.  Had  that  drug  been  given  without  the  patient  having 
been  previously  packed  and  put  in  the  attitude  of  repose,  it 
would  most  probably  have  been  without  effect.  The  wet  sheet 
should  not  be  used  for  more  than  three  hours  at  a  time,  and 
should  be  chano-ed  at  the  end  of  an  hour  and  a  half:  its  true 
purpose  is  medical  treatment,  not  mechanical  restraint. 

Counter -irritation  applied  to  the  shaven  scalp  or  to  the  back 
of  the  neck  was  much  used  formerly,  but  has  now  tacitly  fallen 
out  of  use.  Schroeder  van  der  Kolk,  however,  had  considerable 
faith  in  it,  believing  that  he  got  good  results  from  the  application 
of  strong  tartar  emetic  ointment  or  of  a  blister  to  the  shaven 
scalp ;  and  Dr.  Bucknill  has  thought  it  useful  to  rub  croton  oil 
into  the  scalp  at  the  critical  stage  when  acute  is  passing  into 
chronic  insanity,  and  also  in  chronic  melancholy  with  delusion. 
In  one  case  1  witnessed  a  remarkable  temporary  effect  follow  the 
application  of  a  blister  to  the  nape  of  the  neck.  A  young  lady 
who  had  been  for  several  months  in  a  state  of  melancholic  stupor 
or  of  silent  dementia,  never  having  spoken  a  word,  woke  up  from 
her  stupor  the  day  after  the  blister  had  been  applied  and  talked 
quite  rationally ;  on  the  following  day,  however,  she  was  much 
excited,  and  inclined  to  be  violent,  and  then  subsided  again  into 
her  mute  stupor.  The  experiment  was  repeated  on  another 
occasion  with  a  similar  result,  save  that  her  excitement  and 
violence  were  much  greater  than  on  the  first  occasion.  The 
sudden  effect  in  this  case  might  seem  to  indicate  a  powerful 
therapeutic  agent,  but  I  cannot  say  that  I  have  seen  any  positive 
lasting  benefit  from  the  use  of  blisters  or  setons  in  the  treat- 
ment of  mental  disease.  It  is  a  question,  perhaps,  whether  a 
greater  effect  might  not  be  produced  if  the  counter-irritation 
were  applied  in  a  stronger  and  more  active  fashion  than  is  ever 
done  in  this  country.  One  knows  how  the  convulsions  of  epi- 
lepsy may  be  inhibited  in  even  long-standing  cases  of  tne 
disease  by  the  suppurating   effects  of  severe   local  injury :  a 


XL]  THE  TREATMENT  OF  MENTAL  DISORDEKS.  517 

completely  demented  epileptic,  who  had  two  or  three  fits  regu- 
larly every  day,  fell  on  the  fire  in  one  of  them  and  burnt  the 
back  of  his  hand  and  forearm  severely;  extensive  sloughing 
and  suppuration  followed;  wdiile  this  was  going  on  he  never 
had  a  fit,  and  his  mind  even  grew  much  brighter ;  but  as  soon  as 
healing  of  the  suppurating  surface  began  the  fits  came  back  and 
eventually  were  as  strong  and  frequent  as  ever.  Another  epi- 
leptic of  the  same  class  suffered  a  rupture  of  the  urethra  behind 
a  stricture  which  had  been  overlooked ;  in  consequence  of  the 
extravasation  of  urine  which  took  place  there  was  extensive 
sloughing  of  the  cellular  tissue  and  skin  of  the  perinseum  and 
of  the  low^er  part  of  the  abdomen;  during  this  time  there 
were  no  fits,  but  they  returned  when  the  wounds  healed. 
Placing  these  facts  side  by  side  with  what  we  know  of  the 
inhibitory  effects  of  certain  local  and  general  diseases  upon 
mental  disorder,  we  may  perhaps  entertain  a  hope  that  in  time 
to  come  more  may  be  done  than  is  done  in  the  way  of  treat- 
ment, by  the  invention  of  some  means  of  prolonged  and  active 
counter-irritation  or  inhibition.^ 

After  derangements  of  digestion  and  secretion  have  been  duly 
attended  to  and  put  right,  the  did  of  the  insane  should  be  good 
— plain,  but  abundant.  In  melancholia  and  in  asthenic  mania 
the  symptoms  plainly  call  for  as  much  nourishment  as  can  be 
taken  and  digested  ;  and  even  in  so-called  sthenic  mania,  where 
there  is  much  noisy  excitement  and  turbulent  conduct,  there  is 
enough  present  strain  upon  the  vital  powers,  and  enough  risk  of 
vital  depression  after  the  fury  of  the  storm  is  overpast,  to  make 
it  unwise  to  withhold  liberal  nourishment.  The  good  or  bad 
issue  of  an  attack  of  the  most  acute  mania  will  depend  some- 
times on  whether  sufficient  food  has  been  taken  or  not  during 
its  course  :  if  it  has,  the  excitement  may  continue  for  a  long 

^  Several  cases  have  been  placed  on  record  in  which  epilepsy  following 
injury  to  the  head  has  been  ameliorated,  or  cured — even  when  compUcated 
with  mental  derangement — by  trephining  the  skull  at  the  seat  of  injury. 
When  the  injury  to  the  head  has  not  caused  a  fracture  of  the  skull,  or  even 
a  wound  of  the  scalp,  it  has  sometimes  caused  inflammation  or  thickening 
of  the  bone  and  epilepsy.  In  these  cases  also  the  removal  of  the  bone  by 
the  trephine  has  sometimes  cured  the  epilepsy.  De  la  Trepanation  clans 
V  Epilepsie  par  Traumatismes  der  Ci'diie,  par  le  Dr,  JI,  G.  Echeverria,  1878. 
See  also  case  described  at  page  227, 


548  PATHOLOGY  OF  ^IIND.  [chap. 

time,  and  when  it  is  over  the  patient  still  recover  favourably ; 
if  not,  he  may  sink  from  exhaustion  in  the  midst  of  unabated 
excitement,  or  lapse  into  dementia  when  it  subsides.  It  is 
necessary  to  bear  in  mind,  both  in  acute  insanity  and  in  chronic 
melancholia,  that  the  digestive  powers  are  likely  to  be  weak- 
ened— in  the  one  case  by  the  withdrawal  of  power  from  them 
by  the  maniacal  expenditure  of  vital  energy,  and  in  the  other 
by  the  general  depression  of  the  vital  energies — and  to  take  care 
therefore  that  the  food  which  is  given  is  suitable,  and  is  given  in 
such  form  as  is  most  easy  of  digestion.  There  is  no  wisdom  in 
giving  quantities  of  solid  and  ill-cooked  food  two  or  three  times 
a  day  to  a  patient  who,  if  he  takes  it,  perhaps  swallows  it 
hurriedly  without  masticating  it  properly :  it  should  be  given 
at  more  frequent  intervals,  in  smaller  quantities,  and  in  the  most 
nutritious  forms.  Let  the  melancholic,  for  example,  have  a  diet 
of  this  sort — a  tumbler  full  of  milk  early  in  the  morning,  a  not 
too  heavy  breakfast  in  due  course,  a  cup  full  of  beef  tea  or  soup 
>^bout  eleven  o'clock,  oysters  or  a  small  quantity  of  meat  at 
luncheon  between  one  and  two  in  the  day,  a  dinner  of  not  more 
than  two  courses  about  six  o'clock,  and  a  little  milk  or  arrow- 
root or  beef-tea  before  going  to  bed.  If  he  goes  to  sleep  for  the 
first  part  of  the  night  and  wakes  about  two  or  three  in  the 
morning,  unable  to  go  to  sleep  again,  as  some  melancholies  do, 
a  tea-cupful  of  beef-tea  or  milk,  or  a  small  quantity  of  other 
light  nourishment  taken  then,  will  often  enable  him  to  get  some 
more  sleep. 

Stimulants,  if  necessary,  should  always  be  given  in  modera- 
tion. If  a  patient  is  taking  food  well  and  his  pulse  is  fairly 
good  they  are  not  necessary  at  all ;  but  if  he  has  been  accus- 
tomed to  take  wine  or  beer,  he  may  usually  take  two  or  three 
glasses  of  wine  or  beer  in  the  day  with  his  meals.  The  acute 
maniac,  however,  who  is  taking  food  well  is  in  most  cases  better 
without  any  stimulant,  and  if  he  wants  to  drink  he  can  drink 
nothing  better  than  a  mixture  of  soda  or  seltzer  water  and 
milk.  In  some  cases  of  melancholia  and  of  mania  which  has 
passed  its  meridian  a  glass  of  stout  or  a  little  mulled  claret 
or  a  little  sherry  and  water  just  before  going  to  bed  is  found 
very  useful.      If   adequate  nourishment  be  not  taken,  and  if 


XI.]  THE  TREATMENT  OF  MENTAL  DISORDERS.  649 

the  pulse  begins  to  flutter  and  flag,  then  stimuhmts  may  be 
more  largely  used,  their  use  being  regulated  by  careful  observa- 
tion of  their  effects  :  to  "  pour  in  wine  and  brandy  "  indiscri- 
minately, as  is  sometimes  done,  is  to  my  mind  no  better  than  the 
conduct  of  the  man  who,  affecting  to  imitate  the  example  of  the 
Good  Samaritan,  poured  oil  into  his  enemy's  wounds — but  it 
was  oil  of  vitriol.  A  judicious  use  of  wine  or  other  stimulant 
when  an  attack  of  insanity  is  threatening  will  sometimes  do  a 
great  deal  to  help  to  ward  it  off :  at  that  period  when  a  person 
becomes  unduly  anxious,  irritable,  apprehensive,  and  loses  his 
sleep  night  after  night  under  the  pressure  of  family- troubles  or 
business- worries,  he  may  be  much  benefited  by  taking  some 
stimulant  with  his  food  ;  but  it  must  be  combined  with  other 
measures  of  relief,  for  if  he  relies  upon  it  alone  he  will  be 
tempted  to  increase  the  quantity  taken,  and  his  last  state  will 
be  worse  than  the  first. 

Active  jpiirgation,  once  so  much  favoured,  is  now  quite 
eschewed,  in  the  treatment  of  insanity.  The  ancients  used 
hellebore  largely  for  the  purpose,  in  order  to  purge  away  the 
black  bile  which  they  supposed  to  cause  the  malady;  whence 
the  recommendation  to  a  person  whose  wits  were  astray — Naviget 
Anticyram,  that  being  the  place  where  the  hellebore  flourished. 
Still  one  finds  a  much  too  active  inclination  in  some  instances 
to  make  the  boAvels  act  by  means  of  purgatives :  doses  of 
calomel  or  cathartic  pills  are  given  every  two  or  three  days  to 
stimulate  the  depressed  abdominal  energies  of  the  melancholic ; 
and  even  the  patient  who  is  taking  little  or  no  food  will  run  the 
risk  of  getting  his  purge  if  his  bowels,  which  have  nothing  in 
them  to  act  upon,  do  not  act.  It  is  a  pity  that  those  who  run 
in  this  groove  of  irrational  treatment  do  not  try  the  effect  of  a 
strong  mercurial  purge  upon  themselves  from  time  to  time,  and 
take  notice  how  manj^  days  are  required  after  it  for  the  bowels 
to  recover  from  the  irritation  which  they  have  had  and  to  act 
naturally.  Active  exercise,  abundance  of  suitable  food,  and 
perhaps  cod-liver  oil  are  the  best  means  of  obtaining  a  regular 
action  of  the  bowels  in  some  cases  of  melancholia.  When  a 
purgative  is  needed,  as  it  certainly  may  be  at  the  commence- 
ment of  treatment  and  from  time  to  time  in  melancholia,  the 


650  PATHOLOGY  OF  MIND.  [chap. 

most  simple  is  the  least  harmful  and  therefore  the  best.  Two  or 
three  grains  of  the  extract  of  aloes,  combined  or  not  with  small 
doses  of  the  extracts  of  belladonna  and  of  nux  vomica,  or  a 
compound  rhubarb  pill,  or  a  little  castor  oil,  will  usually  answer 
the  purpose ;  indeed  a  moderate  dose  of  the  last  will  often  suc- 
ceed when  stronger  purgatives  fail,  and  it  has  the  advantage 
that  it  is  not  necessary  to  increase  the  dose  when  it  has  to  be 
given  again.  A  wine-glassful  of  the  Hungarian  aperient  water 
(Hunyadi  Janos)  taken  the  first  thing  in  the  morning  seldom 
fails  to  operate  satisfactorily,  and  is  perhaps  the  most  useful  laxa- 
tive in  melancholia.  A  tumblerful  of  simple  cold  water  early 
in  the  morning  sometimes  answers  the  purpose.  Nothing  is  said 
in  medical  books  of  what  may  be  done  mechanically  by  a 
person  to  provoke  or  assist  an  action  of  his  bow^els ;  but  there 
is  no  doubt  that  by  rubbing  and  kneading  the  abdomen  and 
loins,  alternately  with  three  or  four  blows  on  them,  and  by  a  few 
sharp  taps  over  the  coccyx,  repeated  now  and  then  at  the  time 
of  the  usual  action  of  the  bowels,  they  can,  either  by  direct 
shock  or  in  a  reflex  way,  be  stimulated  to  act  when  they  would 
not  otherwise  do  so. 

I  come  now  to  the  consideration  of  the  propriety  of  the  free 
use  of  so-called  sedatives  in  insanity.  It  is  a  practice  which  is 
almost  universal  among  medical  men,  when  they  have  to  do 
with  a  case  of  mental  disease,  to  prescribe  sedatives  in  order  to 
subdue  excitement  and  to  procure  sleep,  and  the  consulting 
physician  meets  in  consequence  from  time  to  time  with  disas- 
trous effects  from  the  reckless  use  of  large  and  often-repeated 
doses  of  chloral  hydrate.  Opinion  is  yet  divided  as  to  the  value 
of  this  and  other  sedatives,  and  while  one  physician  at  the 
head  of  a  large  asylum  denounces  them  earnestly,  another  who 
has  had  as  large  a  field  of  practice  cannot  speak  too  well  of 
them. 

Some  years  ago  I  took  occasion  to  put  the  question  plainly 
whether  it  was  a  rational  and  proper  thing  to  stifle  mental  ex- 
citement by  means  of  sedatives,^  and  to  suggest  that  it  should 
be  considered  seriously  whether  the  putting  the  nerve-cells  of 

1  In  a  presidential  address  on  Insanity  and  its  Treatment  to  the  Medico- 
Psychological  Association.     Journal  of  Mental  Science,  October,  1871. 


XI.]  THE  TREATMENT  OF  MENTAL  DISORDERS.  551 

the  patient's  brain  into  chemical  restraint,  so  to  speak,  did 
really  benefit  them.  The  answer  to  this  sceptical  inquiry,  on 
the  part  of  the  advocates  of  sedatives,  has  been  more  confident, 
I  think,  than  well  considered.  It  amounts  really  to  this — that 
it  must  be  a  benefit  to  get  sleep  where  there  is  sleeplessness,  and 
that  it  is  certainly  proper  to  extinguish  a  fire  which  is  burning 
down  a  house.  But  it  is  not  considered,  not  even  suspected 
apparently,  that  natural  sleep  and  narcotic-enforced  sleep  may 
be  tw^o  different  conditions  and  ought  not  perhaps  to  be  spoken 
of,  without  more  discrimination,  by  the  common  name  of  sleep. 
A  patient  can  be  made  unconscious  by  chloral  hydrate  undoubt- 
edly, just  as  he  can  by  the  administration  of  chloroform,  but 
what  is  wantincr  is  the  knowledge  that  in  either  of  these  or 
similar  artificial  states  the  same  sort  of  repair  and  restoration 
of  nerve-element  takes  place  which  takes  place  in  natural  sleep. 
Exact  information  with  respect  to  that  point  may  be  set  down 
as  entirely  wanting  :  the  chloral-produced  state  looks  like  sleep, 
and  all  the  rest  has  been  assumed.  The  second  reason,  if 
reason  it  can  be  called  which  is  an  analogical  will-o'-the-wisp, 
namely,  that  it  is  proper  to  put  out  a  fire,  might  be  fairly  met 
by  the  question  whether  it  is  clear  that  the  sedative,  albeit  it 
dulls  the  flame  in  the  first  instance,  is  not  in  the  end  fuel  to  it. 
Does  the  patient  wake  up  any  better  from  his  enforced  sleep, 
or  is  he  not  usually  wound  up  thereby  to  a  greater  excite- 
ment w^hen  he  comes  out  of  it  ?  Moreover,  is  the  period  of 
excitement  really  shortened  in  the  long  run  and  recovery  pro- 
moted, or  is  it  lengthened  and  the  lapse  into  chronic  insanity 
favoured  by  the  frequent  use  of  the  sleep-compelling  drug  ? 
These  are  the  weighty  questions  which  require  to  be  considered 
and  answered  by  more  numerous  and  careful  observations  than 
have  yet  been  made. 

There  is  yet  another  argument  in  favour  of  the  use  of  sedatives 
w^hich,  as  it  has  something  of  a  scientific  semblance,  it  will  be 
proper  to  mention.  It  is  based  upon  our  knowledge  of  the  phy- 
siological antidotal  effect  which  one  poison  has  to  another — 
belladonna  to  opium,  for  example,  chloral  hydrate  to  strychnia 
Seeing  that  a  poisonous  dose  of  strychnia,  which,  given  by 
itself,  would  of  a  certainty  quickly  kill  an  animal  in   tetanic 


552  PATHOLOGY  OF  MIND.  [chap. 

convulsions,  may  be  given  to  it  without  fatal  results  when  a 
full  dose  of  chloral  hydrate  is  given  at  the  same  time,  is  it  not 
probable  that  chloral  hydrate  has  a  like  good  effect  in  suppress- 
ing the  convulsive  fury  of  a  deranged  mind  ?  Here,  again,  it 
is  to  be  feared  that  the  analogy  goes  on  one  foot.  Any  animal 
will  recover  from  a  dose  of  strychnia  if  it  can  be  kept  alive  until 
the  poison  is  excreted  from  the  body,  which  begins  to  happen 
soon  after  it  is  taken :  if  the  spinal  cord,  therefore,  upon  which 
the  poison  acts,  can  be  rendered  less  sensible  to  its  action  while 
it  is  in  the  body,  there  is  nothing  more  to  be  feared  when  the 
poison  has  been  eliminated.  But  that  is  not  so  in  mania.  The 
cases  are  few,  if  any,  in  which  we  have  reason  to  suppose  that 
the  excitement  is  owing  to  the  direct  action  of  a  poison  intro- 
duced from  without  or  bred  in  the  body,  which  the  body  i& 
hastening  to  get  rid  of  by  its  excretions,  and  the  physiological 
action  of  wdiich  the  sedative  counteracts  whilst  it  is  in  it.  More- 
over, such  a  largely  used  sedative  as  opium  positively  hinders 
excretion  by  its  secretion-checking  action. 

The  truth  is  that  the  only  valid  appeal  in  this  matter  is  to 
experience.  If  that  has  proved  the  benefit  of  sedatives  in  the 
treatment  of  mania  we  must  accept  the  fact,  although  we  cannot 
yet  discover  the  theory  of  their  action,  just  as  we  are  compelled 
for  the  present  to  be  content  to  know  that  quinine  cures  ague 
without  knowing  how  it  cures  it.  Unhappily  experience  speaks 
with  directly  contradictory  voices :  one  physician  of  an  asylum, 
after  full  trial  of  the  hydrate  of  chloral,  endorses  the  description 
of  it  as  "  crystallised  hell ; "  another  considers  it  the  most  useful 
drug  we  have  in  the  treatment  of  insanity :  one  physician 
declares  most  confidently  that  the  one  form  of  insanity  in  which 
opium  or  chloral  is  unquestionably  pernicious  is  acute  delirious 
mania ;  another  physician  boasts  that  he  has  never  lost  a  case 
of  acute  delirious  mania  since  he  has  freely  used  chloral  hydrate 
in  the  treatment  of  it.  Such  are  the  contradictory  voices  of 
experience.  One  requires  to  know  the  character  of  the  experi- 
menter in  order  to  decide  which  voice  to  trust ;  albeit  one  may 
feel  pretty  sure  in  a  question  of  the  action  of  a  medical  drug^ 
that  he  who  is  least  heroic  in  his  use  of  it,  and  least  confident 
in  his  opinion  of  its  powers,  will  be  most  likely,  in  virtue  of  his 


XI.]  THE  TEEATMENT  OF  MENTAL  DISORDERS.  553 

mental  temperament,  to  have  oLserved  accurately  and  to  have 
inferred  soundly. 

Perhaps  some  confusion  and  contradiction  have  been  caused  by 
tlie  failure  to  keep  in  mind  the  different  aims  with  which  seda- 
tives are  used.  A  large  and  ordinary  use  of  them  in  some  asylums 
is  for  the  purpose  of  stifling  excitement  and  producing  quiet,  the 
nurses  being  supplied  night  after  night,  and  in  the  day  also 
sometimes,  with  draughts  of  chloral  hydrate  or  of  other  seda- 
tives, to  be  administered  to  certain  patients  who  are  excited, 
noisy,  or  sleepless.  They  are  used,  in  fact,  as  mechanical 
restraints  have  been  unwisely  used — namely,  to  keep  a  tur- 
bulent patient  quiet.  But  it  does  not  follow,  if  they  fulfil  that 
aim,  that  they  at  the  same  time  fulfil  the  aim  of  promoting 
recovery ;  on  the  contrary,  it  is  conceivable  that  they  may  have 
the  quieting  effect  wished  for  and  yet  not  really  promote  recovery. 
That  may  well  require  another  treatment.  And  yet  so  little  is 
this  considered  that  one  frequently  hears  the  long-continued 
use  of  some  sedative  lauded  with  nawe  exultation,  and  with- 
out a  word  being  said,  or  apparently  without  a  thought  being 
given,  as  to  whether  patients  recovered  better,  or  recovered  at 
all,  by  taking  it.  *'  Where  the  methodical  use  of  morphia 
injections  is  practised,"  says  an  enthusiastic  writer  in  a  recent 
number  of  a  German  periodical,  "  the  restraints  and  costly 
divisions  of  asylums  for  violent  cases,  with  their  cells,  may 
be  banished."^  That  is  to  say,  chemical  restraint  of  the  cells 
of  the  sick  brain  may  be  made  to  supersede  entirely  the 
mechanical  restraint  of  the  body.  The  successful  argument 
against  mechanical  restraint  was,  that  although  it  kept  the 
patient's  body  quiet,  it  really  aggravated  his  malady:  the 
question  now  which  should  be  considered  is,  whether  chemical 
restraint  does  permanent  good,  or  whether  by  diminishing 
excitement  at  the  ultimate  cost  of  mental  power  it  "makes 
a  solitude  and  calls  it  peace." 

Undoubtedly  the  great  majority  of  the  inmates  of  every  large 
asylum  are  persons  who  never  will  recover,  be  the  medical  treat- 
ment what  it  may.  Those  who  drug  the  troublesome  ones  into 
stupor  cannot  therefore  be  justly  charged  with  jeopardising  their 

^  Dr.  Wolf,  Archivfur  PsycJnatrieu.  NervenkranJcheiten,  B.  ii.  §  601. 


554  PATHOLOGY  OF  MIND.  [chap. 

recoveiy ;  but  it  is  not  so  clear  that  they  are  free  from  the 
charge  of  practising  recklessly  a  system  of  treatment  which 
the  experience  of  the  best- conducted  asylums  proves  to  be 
unnecessary,  if  not  actually  pernicious.  There  cannot  be  such 
differences  between  asylums  as  to  make  invaluable  in  one  what 
is  baneful  in  another.  Dr.  Clouston  was  at  the  pains  to  conduct 
a  series  of  researches  into  the  effects  of  the  continued  use  of 
frequent  doses  of  opium  upon  patients  in  the  Cumberland 
Asylum,  and  he  found  the  result  to  be— that  the  opium  soon 
lost  its  effect ;  that  all  the  patients  lost  weight  while  taking 
it;  that  their  average  temperature  fell;  that  the  pulse  was 
lowered;  and  that  in  all  cases,  to  use  his  words,  "it  inter- 
fered with  the  proper  nutrition  of  the  body  and  pushed  it  one 
step  further  downhill  in  the  direction  of  death."  If  such 
be  the  effects  of  opium,  what  may  be  expected  of  the  long  con- 
tinued use  of  chloral,  seeing  that  it  is  certainly  more  injurious 
to  the  nutrition  of  the  body,  and  particularly  of  the  brain,  than 
opium  ?  The  habitually  chloral-dosed  patients  in  an  asylum 
may  be  recognised  for  the  most  part,  I  believe,  by  their  miserable 
appearance.  Be  that  as  it  may,  the  regular  use  of  chloral,  or 
any  other  sedative,  in  order  to  produce  a  stuporous  quiet,  is 
not  yet  proved  to  be  any  more  scientific  than  it  would  be  to 
place  the  patients  in  suitably  constructed  chambers  and  to 
render  them  insensible,  as  might  be  done,  by  supplying  the 
chambers  with  a  calculated  mixture  of  air  and  carbonic  acid. 

As  regards  the  use  of  sedatives  for  the  purpose  of  aiding  to 
bring  about  recovery  in  acute  insanity,  my  experience  is  that 
while  their  occasional  use  may  be  necessary  and  beneficial,  their 
repeated  use  day  after  day  and  night  after  night  is  unques- 
tionably injurious — promoting  death  or  dementia.  And  I  am 
not  sure  whether  they  ever  produce  a  beneficial  sleep  except  in 
cases  in  which,  with  a  little  patience,  sleep  would  have  been 
obtained  without  them.  Certainly  in  any  case  they  should  be 
looked  upon  as  adjuncts  of  treatment,  not  as  the  backbone  of  it. 
Opium,  which  was  formerly  much  used,  has  been  ousted  from 
its  place  by  the  hydrate  of  chloral ;  nevertheless  I  believe  it  to 
be  a  more  useful  and  less  dangerous  drug.  I  have  found  it  of 
more   service  when  an  attack  of  insanity  from  moral  causes 


XI.]  THE  TREATxMENT  OF  MENTAL  DISORDERS.  555 

seems  to  threaten  tlian  when  it  has  burst  out :  at  the  beginning 
of  the  mental  depression  and  apprehension,  when  the  patient  is 
nervous,  depressed,  fearful,  and  cannot  sleep,  a  dose  of  opium 
each  night  for  two  or  three  nights  will  procure  sleep  and  some- 
times do  great  good ;  and  in  other  cases  small  stimulant  doses 
of  morphia  two  or  three  times  a-day  appear  to  be  of  real  use. 
I  certainly  think  that  I  have  seen  an  imminent  attack  of  insanity 
warded  off  and  tranquillity  of  mind  restored  by  this  sort  of 
treatment.     But  there  are  two  things  to  be  borne  in  mind  wuth' 
regard  to  opium:   first,  that  there  are  some  persons  whom  it 
does  not  suit  at  all,  and  it  is  impossible  to  say,  before  trying  it, 
whether  it  will  suit  or  not ;  and,  secondly,  that  it  is  always  far 
more  useful  in  old  than  in  young  persons.     In  acute  mania  and 
in  melancholia  agitans,  I  have  never  seen  the  least  good,  and  I 
have  often  seen  the  greatest  harm,  done  by  the  frequent  use  of 
opium.     It  is  possible  to  get  a  fitful  sleep  of  an  hour  or  two,  in 
most  cases,  if   large  enough  doses  be  given,  but  the  patient 
wakes  up  more  excited  and  incoherent,  and  if  the  medicine  be 
continued  he  is  far  more  likely  to  sink  from  exhaustion  during 
the  storm,  or  into  dementia  after  it.     The  important  point  is  to 
take  care  that  he  gets  sufficient  food  during  the  paroxysm;  but 
the  effect  of  the  opium  is  to  check  his  secretions,  to  lessen  any 
appetite  he  may  have  for  food,  and  to  produce  a  dry,  brown 
tongue,  which  goes   before  a  fatal  collapse.     If  there  be  any 
kidney  disease  the  use  of  opium  is  still  more  prejudicial.     It  is 
always  more  likely  to  do  good  in  the  forms  of  sub-acute  and 
asthenic  mania  in  elderly  persons  than  in  any  form  of  acute  and 
sthenic  mania ;  and  it  is  not  of  the  least  use  in  acute  delirious 
mania,  in  recurrent  mania,  in  epileptic  mania,  and  in  the  attacks 
of  mania  that  occur  in  the  course  of  general  paralysis.     In  any 
case  in  which  it  is  given  I  should  be  disposed  to  lay  down  the 
practical  rule  that  if  one  or  two  full  doses  do  not  procure  sleep 
and  manifest  relief,  its  use  should  not  be  continued. 

The  effects  of  steadily  increased  doses  of  opium  two  or  three 
times  a  day  have  been  much  praised  in  melancholia.  Certainly 
it  does  not  appear  ever  to  do  the  harm  in  melancholia  which  it 
does  in  mania,  but  it  is  obvious  that  a  careful  discrimination 
should  be  made  of  the  cases  in  which  this  free  use  of  it  is 


556  PATHOLOGY  OF  MIND.  [chap. 

adopted.  If  there  were  a  gross  liabit  of  body  with  defective 
secretion  and  excretion,  or  if  the  melancholia  owned  a  gouty 
origin,  it  would  not  be  a  rational  treatment,  whereas  it  might 
be  of  service  in  the  melancholia  which  was  produced  by  poor 
nutrition  and  depressing  moral  causes,  and  especially  in  the 
melancholia  of  advanced  age.  The  wise  physician  will  treat 
his  patient,  not  an  abstract  melancholic  entity.  My  experi- 
ence of  this  heroic  opium-treatment  does  not  warrant  me  to 
speak  confidently  in  its  favour ;  and  my  preference  is  for  the 
use  of  small  and  repeated  doses  of  morphia  in  those  cases  of 
melancholia  in  asthenic  and  aged  persons  in  which  alone  I  am 
tempted  to  continue  the  use  of  the  drug. 

The  hypodermic  injection  of  morphia  may  be  had  recourse  to 
when  there  is  a  refusal  to  take  medicine,  and  the  drug  operates 
in  this  way  more  certainly,  quickly,  and  effectually  than  when 
taken  by  the  mouth.  Not  more  than  one-fourth  of  a  grain  should 
be  injected  in  the  first  instance,  the  quantity  being  increased 
afterwards,  if  necessary.  I  have  not  seen  more  positive  good 
done  by  hypodermic  injections  than  when  the  drug  was  taken 
by  the  mouth ;  certainly  it  will  not  quench  the  fury  of 
acute  mania,  or  of  acute  melancholia,  nor  does  it  seem  to  be 
a  desirable  practice  to  commence  in  chronic  insanity;  and  I 
have  more  than  once  seen  successive  injections  of  morphia, 
administered  for  the  purpose  of  subduing  excitement,  followed 
suddenly  by  fatal  collapse  or  coma. 

Of  chloral  hydrate,  as  frequently  used,  I  entertain  a  bad 
opinion,  and  I  much  fear  that  its  discovery  has  been  thus  far,  not 
a  good,  but  an  evil,  to  the  human  race.  A  single  dose,  or  an 
occasional  dose  from  time  to  time,  at  the  commencement  or  iu 
the  course  of  mental  disorder,  as  a  palliative,  may  certainly  be 
useful,  but  its  habitual  use  is  pernicious.  This  is  a  case  which 
is  not  very  uncommon  :  a  person  finds  himself  becoming  nervous, 
apprehensive,  sleepless,  and  unable  to  face  the  cares  and  re- 
sponsibilities of  his  business;  he  nerves  himself  for  his  work 
by  taking  some  stimulant  from  time  to  time  in  the  day,  and  he 
evades  the  horrors  of  a  sleepless  night  by  taking  a  dose  of 
chloral  when  he  goes  to  bed ;  this  practice  is  continued  from 
day  to  day  and  week  to  week  with  no  other  effect  than  to  make 


XI.]  THE  TREATMENT  OF  MENTAL  DISORDERS.  567 

matters  gradually  worse;  and  the  end  perhaps  is,  if  better 
counsels  prevail  not,  that  he  commits  suicide  or  breaks  down 
into  actual  insanity.  When  that  which  may  be  used  fitly  as  a 
temporary  help — whether  it  be  stimulant  or  narcotic — is  resorted 
to  as  an  abiding  stay,  the  result  cannot  fail  to  be  disastrous. 
When  chloral  is  given  in  acute  insanity  in  order  to  enforce  sleep 
it  succeeds  in  most  cases,  if  the  dose  given  be  large  enough,  but 
I  have  never  observed  that  the  patient  was  any  better  for  the 
sleep  so  obtained ;  on  the  contrary,  my  experience  is  that  he  is 
oftentimes  more  excited  and  insane  when  he  wakes,  and  that  the 
attack  in  the  end  lasts  longer  than  when  no  chloral  is  given. 
The  worst  cases  of  insanity  which  I  have  seen  have  been  cases 
in  which  large  and  repeated  doses  of  chloral  had  been  given 
for  some  time.  The  most  violent  case  of  puerperal  mania  was 
one  in  w^hich  forty  grains  had  been  given  three  times  a  day  for 
three  or  four  weeks ;  and  in  this  case  the  patient  began  to  mend 
a  few  days  after  the  chloral  had  been  entirely  stopped,  and 
eventually  recovered.  Had  it  been  continued  I  have  not  the 
least  doubt  that  the  lady  would  have  died  or  become  demented.^ 
On  another  occasion  I  was  summoned  in  haste  to  see  a  young, 
strong,  and  handsome  woman  who,  suffering  from  puerperal 
mania  after  the  birth  of  her  first  child,  had  been  given  dose  after 
dose  of  chloral  for  two  days  in  order  to  subdue  excitement  and 
produce  quiet ;  and  certainly  it  had  had  its  effect,  for  she  was 
dying  from  syncope  when  I  saw  her,  and  died  two  hours  after- 
wards. It  is  one  of  three  cases  in  which  I  have  known  repeated 
large  doses  of  chloral  to  cause  death  suddenly  by  fatal  syncope : 
a  possible  danger  which  should  never  be  lost  sight  of  when  large 

^  As  an  illustration  of  the  persistence  with  which  chloral  is  sometimes 
given,  in  spite  of  evidence  of  the  want  of  any  benefit,  and  indeed  of  the 
positive  harm  done  by  it,  I  may  mention  a  case  of  acute  hysterical  mania 
which  I  was  asked  to  see  once.  Full  doses  of  chloral  had  been  given 
twice  a  day  for  weeks,  and  a  larger  dose  at  night.  But  the  excitement  had 
not  been  abated  in  the  least,  and  the  mental  state  was  worse  ;  moreover, 
matters  had  reached  the  pass  that  it  was  impossible  to  get  the  young  lady 
to  take  it  by  the  mouth.  The  daily  doses  had  perforce,  therefore,  been 
abandoned,  and  the  nightly  dose  was  administered  by  the  rectum.  But  as 
there  was  great  struggling,  and  much  difficulty  in  doing  it,  the  patient 
was  every  night  rendered  insensible  by  chloroform  and  the  dose  then 
injected.  The  treatment  was  discontinued  for  a  few  days  but  recurred  to 
afterwards,  I  believe,  and  eventually  the  patient  died. 


658  PATHOLOGY  OF  MIND.  [chap. 

doses  are  freely  given.  Like  opium,  its  benefitg  are  more  mani- 
fest, and  the  harm  which  it  does  is  less,  in  melancholia  than  in 
active  mania ;  but  here  also  its  use  should  be  occasional  rather 
than  habitual — a  help  for  the  time  until  other  and  more  per- 
manent measures  of  relief  can  be  adopted.  Dr.  Clouston  and 
others  have  spoken  favourably  of  the  virtues  of  chloral,  when 
given  to  epileptics,  in  warding  off  post-epileptic  mania. 

In  cases  of  great  excitement,  maniacal  or  melancholic,  in 
which  opium  and  chloral  are  to  be  eschewed,  full  doses  of 
digitalis  will  sometimes  produce  good  tranquillising  effects. 
Digitalis  was  indeed  much  esteemed  by  old  writers  on  insanity, 
and  has  now  been  restored  to  favour  after  having  fallen  into 
disuse  for  some  time.  Under  its  use  the  excitement  may  abate, 
and  the  pulse,  falling  in  frequency,  may,  by  repeating  the  dose, 
be  kept  for  some  time  at  a  standard  below  the  average.  The 
effects  are  certainly  excellent  as  a  rule,  and  marvellous  some- 
times, in  the  maniacal  outbreaks  which  take  place  in  the  course 
of  general  paralysis.  Two  cautions  seem  to  be  prudent  in  the 
employment  of  it :  first,  to  begin  with  a  dose  of  about  half  a 
drachm  of  the  tincture  rather  than  with  doses  of  one  drachm  or 
two  drachms,  until  experience  has  been  obtained  of  its  effects 
upon  the  pulse  ;  and,  secondly,  not  to  continue  the  frequent  use 
of  large  doses  without  carefully  watching  the  effects.  Formerly 
it  was  supposed  to  be  a  cumulative  drug,  that  is  to  say,  to  ac- 
cumulate in  the  system  when  given  in  moderate  doses  until  it 
suddenly  produced  dangerous  or  even  fatal  effects,  and  albeit 
that  opinion  of  its  effects  is  not  now  entertained  generally, 
death  has  sometimes  taken  place  rather  suddenly  after  repeated 
large  doses  of  digitalis.  It  would  certainly  appear  that  although 
a  patient  who  has  taken  large  doses  may  be  safe  while  lying 
down,  he  runs  some  risk  of  fatal  collapse  if  he  starts  up  suddenly 
or  runs  about  in  an  excited  manner. 

Hyoscyamus  is  a  useful  sedative  in  cases  of  insanity,  but  it 
must  be  given  in  doses  of  a  drachm  or  of  two  drachms  of  the 
tincture.  Like  digitalis,  and  also  chloral,  it  acts  better  when 
combined  with  bromide  of  potassium  than  when  given  alone. 
It  will  oftentimes  fail  to  produce  any  marked  effect,  but  I  have 
never  seen  any  ill  effect  other  than  loss  of  appetite  and  sickness 


XI.]  THE  TIIEATMENT  OF  MENTAL  DISORDERS.  550 

from  its  continued  use.  Its  alkaloid,  hyoscyamine,  has  iDeen 
recently  employed,  having  been  recommended  by  Dr.  Lawson 
after  a  series  of  experiments  at  the  West  Riding  Asylum.  It 
is  a  very  powerful  drug,  producing,  in  small  doses  of  -^V  or  Jg-  of 
a  grain,  similar  poisonous  symptoms  to  those  which  are  produced 
by  unlimited  quantities  of  the  tincture  of  hyoscyamus — namely, 
loss  of  power  in  the  limbs  ending  in  paralysis  shown  by  stag- 
gering gait  and  ultimate  inability  to  stand,  mental  torpor  and 
rambling  delirium,  extreme  dryness  of  the  throat  rendering 
swallowing  difficult  or  impossible,  and  great  dilatation  of  the 
pupils.  Twelve  hours  must  elapse  before  these  effects  pass 
away,  and  two  or  three  days  in  some  cases  before  the  patient 
recovers  entirely  from  the  mind-prostrating  after-effects.  On 
account  of  the  great  dryness  of  throat  and  the  loss  of  appetite 
which  it  produces  it  cannot  safely  be  given  in  any  form  of 
asthenic  mania,  in  which  it  is  important  that  the  patient  should 
not  cease  to  take  food ;  its  use  must  be  limited  to  cases  of  noisy 
and  turbulent  mania  in  which  there  is  vigour  enough  to  spare 
and  no  risk  of  fatal  exhaustion  from  the  mental  and  physical 
prostration.  But  it  is  not  alleged  that  it  promotes  recovery  in 
these  cases  ;  all  that  is  claimed  for  it  is  that  it  renders  such 
patients  much  quieter.  Indeed,  they  evince  oftentimes  a 
singular  dislike  and  dread  of  it,  being  much  frightened  by  the 
remembrance  of  the  effects  which  it  produced  upon  them. 
Dr.  Savage  has  tried  the  alkaloid  recently  at  Bethlehem  Hospital 
in  some  cases  of  violent  mania  and  in  a  case  of  melancholia, 
and  his  experience  is  that  it  has  done  no  good,  but  harm.  In 
one  case  of  mania  the  treatment  was  discontinued  after  two 
months  as  the  patient  "was  becoming  alarmingly  thin  and 
sallow  in  appearance  " ;  in  another  case  it  was  discontinued  in 
consequence  of  the  loss  of  weight  and  strength  which  occurred; 
in  the  case  of  melancholia  the  patient  "  was  rendered  worse  in 
body  and  no  whit  better  in  mind."  The  instincts  of  the  patients 
sometimes  rebelled  energetically  against  it :  one  of  them,  when 
she  saw  Dr.  Savage,  used  to  become  violent  and  call  him  a 
murderer ;  another  was  enraged  and  struck  him,  calling  him 
a  "  poisoner."  In  the  case  of  henbane  then,  as  in  the  case  of 
other  sedatives,  w^e  find  that,  while  its  occasional  use  may  be  of 


5G0  PATHOLOGY  OF  MIND.  [crap. 

service,  the   more  heroic  the    treatment,   the   greater  is    the 
harm  done. 

Conium,  a  drug  the  action  of  which  is  very  like  that  of 
hyoscyamus,  has  been  hotly  recommended  in  the  form  of  the 
Succus  conii.  A  dose  of  one  drachm  or  two  drachms  is  to  be 
given  in  the  first  instance,  but  it  may  be  increased  up  to  as 
much  as  one  or  two  ounces,  three  times  a  day,  it  is  said,  and  be 
advantageously  combined  with  bromide  of  potassium.  That  it 
lessens  the  excitement  of  the  paroxysms  in  some  cases  of 
recurrent  mania,  failing  to  do  so  in  others,  seems  to  be  pretty 
certain,  but  there  is  not  sufficient  evidence  that  it  does  per- 
manent good  to  the  deranged  mind.  Dr.  Savage  found  in  some 
cases  a  marked  tendency  to  weak-mindedness  follow  the  use  of 
the  drug,  and  although  this  might  not  have  been  due  to  it,  he 
was  impressed  with  the  fact  that  the  more  he  pressed  its  use 
the  more  marked  was  the  mental  weakness.  If  this  were  really 
so,  there  would  be  no  cause  for  surprise:  the  Datura  stra- 
monium, which  resembles  conium  and  hyoscyamus  in  its 
physiological  action,  is  used  largely  for  poisonous  purposes  in 
India,  and  it  has  been  observed  that  some  days  elapse  before 
those  who  have  suffered  severely  from  its  effects  recover  their 
memories  and  mental  powers  completely.  For  my  part  I  do  not 
doubt  that  a  patient  will  certainly  recover  who  is  taking  repeated 
large  doses  of  Succus  conii,  if  only  the  vis  medicatrix  natiirce  be 
strong  enough  to  get  the  better  of  the  disease  and  of  the 
druGj. 

o 

Dr.  Clouston  has  praised  highly  a  mixture  of  Cannabis  inclica 
and  bromide  of  potassium  as  a  sedative,  and  he  contrasts  the 
effects  of  its  repeated  use  with  those  which  follow  the  use  of 
opium,  much  to  the  disadvantage  of  the  latter.  The  excitement 
was  subdued ;  the  medicine  did  not  lose  its  effect  after  nine 
months'  use  ;  the  appetite  was  not  interfered  with ;  the  weight 
of  the  patients  increased ;  and  the  temperature  fell.  In  fact, 
the  maximum  of  good  effects  and  the  minimum  of  ill  effects 
were  obtained  b}^  him.  What  one  misses,  however,  in  the  record 
of  these  experiments  is  a  ratio  of  recoveries  in  proportion  to  the 
virtues  of  the  remedy ;  it  is  true  that  eighty  per  cent,  of  the 
patients   were  more  or  less  benefited,  but  only  one  recovered. 


XI.]  THE  TKEATxMENT  OF  MENTAL  DISORDERS.  661 

A  sceptical  inquirer  might  desire  to  put  the  question  whether 
it  had  been  considered  how  many  recoveries  were  prevented. 

I  shaU  say  little  of  other  sedatives,  because  I  have  nothing  to 
add  to  what  I  have  already  said  in  the  foregoing  pages.  Bromide 
of  potassium  is  very  largely  used  in  all  sorts  and  conditions  of 
mental  and  nervous  troubles,  and  there  cannot  be  a  doubt  of  its 
value  both  when  given  alone  and  in  combination  with  one  or 
other  of  the  before  mentioned  sedatives.  But  it  would  certainly 
be  well  to  have  set  forth  more  plainly  than  has  been  done  yet 
the  exact  indications  for  its  administration,  since,  as  matters 
are  at  present,  a  patient  gets  bromide  of  potassium  if  he  is 
maniacal  or  melancholic,  if  he  is  in  good  spirits  or  in  low  spirits, 
if  he  is  sleepless  or  sleeps  too  much,  if  he  has  acute  pains  or 
distressing  numbness  in  the  head — in  fact,  in  whatsoever  tribu- 
lation of  mind  or  brain  he  may  be.  It  appears  to  produce 
specially  good  effects  in  cases  of  hysterical  insanity,  and  when- 
ever there  is  evidence  of  sexual  excitement ;  and  it  is  certainly 
of  the  greatest  service  in  recent  epilepsy.  I  have  not  seen  any 
benefit  from  its  use  in  recurrent  insanity ;  nor  am  I  tempted  to 
employ  it  in  old-established  epilepsy  with  mental  complications, 
since  the  present  suppression  of  the  fits  by  it  seems  to  be 
followed  in  some  instances  after  a  ^vhile  by  an  outburst  of  fits 
and  fury  which  is  positively  appalling.  As  a  simple  and  harm- 
less means  of  procuring  sleep  it  is  of  value ;  and  its  ef&cacy  for 
this  end  will  be  found  to  be  increased  sometimes  by  giving  it  at 
bedtime  in  a  glass  of  beer  or  porter.  Hydrocyanic  acid  in  large 
doses,  like  every  other  sedative,  has  had  its  eager  advocates. 
I  have  not  used  it  in  heroic  doses,  but  in  ordinary  full  doses  it 
has  appeared  to  do  good  in  some  cases  of  mania  in  which  there 
was  evidence  of  irritation  and  excitement  of  abdominal  and 
pelvic  organs ;  acting  in  that  case,  perhaps,  indirectly  as  a  seda- 
tive to  the  brain  by  a  direct  sedative  action  on  parts  the  activity 
of  which  was  working  prejudicially  upon  the  brain.  Tartar 
emetic  was  at  one  time  much  used  in  asylums  for  the  same 
purpose  as  chloral  is  used  now,  namely,  to  tranquillise  noisy, 
excited,  and  troublesome  patients,  and  it  has  also  been  employed 
in  the  medical  treatment  of  acute  mania.  In  the  latter  case,  if 
it  be  given  in  a  large  enough  dose  it  will  produce  the  peace  of 


562  PATHOLOGY  OF  MIND.  [chap. 

prostration,  but  the  temporary  lull  of  excitement  is  followed  by 
a  recurrence  of  it  when  the  patient  recovers  from  the  effects  of 
the  drug,  and  to  go  on  repeating  the  doses  will  be  likely  to  caiise 
loss  of  appetite  where  the  necessity  of  food  is  urgent,  and  ulti- 
mate injurious  depression.  On  the  other  hand,  strong,  turbulent, 
restless  chronic  maniacs,  in  whom  the  pulse  is  regular,  the 
tongue  clean,  the  bodily  health  nowise  affected — in  whom  the 
body  seems  to  have  thoroughly  acclimatised  itself,  so  to  speak, 
to  the  mania — suffer  no  harm  from  full  doses  of  tartar  emetic, 
if  it  does  them  no  good. 

The  foregoing  remarks  will  no  doubt  appear  to  some  persons 
to  be  inspired  by  a  spirit  of  exaggerated  scepticism  with 
respect  to  the  value  of  sedatives  in  the  treatment  of  insanity, 
Let  it  not  be  overlooked  therefore  that  they  refer  not  to  their 
occasional  use  as  adjuvants  of  other  well-considered  measures, 
but  to  their  repeated  use  day  after  day  and  night  after  night  in 
order  to  abate  an  excitement  which  they  will  not  abate,  and  to 
enforce  a  sleep  which,  so  enforced,  does  no  good.  It  is  foolish 
to  expect  that  a  person  who  is  suffering  from  acute  mania  will 
have  anything  like  the  quantity  of  sleep  which  a  sane  person 
gets,  and  unwise  to  try  to  force  him  into  it  by  stupefying  drugs. 
If  he  does  not  sleep  one  night,  he  will  probably  sleep  for  a 
part  of  the  next  night,  and  if  we  wait  patiently,  taking  care 
meanwhile  to  attend  to  his  special  constitutional  state,  and  to 
provide  that  he  takes  abundance  of  exercise  in  the  open  air, 
that  he  gets  sufficient  food,  that  he  has  baths  if  he  will  take 
them,  and  that  his  surroundings  are  such  as  are  not  likely  in  any 
way  to  irritate  his  disordered  brain  and  to  add  to  his  excite- 
ment, w^e  shall  happily  find  that  the  natural  sleep  which  he 
obtains  by  fitful  snatches  increases  gradually  in  amount ;  and 
we  may  be  content  that  a  few  hours  of  such  natural  sleep,  even 
if  obtained  only  on  alternate  nights,  will  be  worth  more  to  him 
in  the  end  than  a  whole  night  of  chloral-enforced  insensibility. 
As  regards  melancholies,  it  is  to  be  noted  that  they  oftentimes 
sleep  more  than  they  think  and  say  they  do  ;  and  it  is  well 
therefore  before  treating  them  for  sleeplessness  to  have  the 
evidence  of  some  one  who  has  watched  them  through  the  night. 
Moreover,  if  they  have  been  wont  to  have  sedative  draughts  fox 


XI.]  THE  TREATMENT  OF  MENTAL  DISORDERS.  563 

some  time,  they  will  protest  tliat  they  cannot  sleep  a  wink 
without  them  ;  albeit,  if  the  strength  of  the  draught  be  lessened 
without  their  knowledge,  a  taste  of  the  drug  only  being  left  in 
it  perhaps,  they  sleep  fairly  well.  In  some  cases  a  small  quan- 
tity of  light  nourishment  taken  in  the  night  when  they  wake  up 
from  their  first  sleep  and  begin  to  toss  about  in  the  mental 
agony  of  a  succession  of  tormenting  thoughts,  will  procure 
calm  and  sleep.  For  example,  an  old  gentleman  with  a  feeble 
heart,  suffering  from  melancholic  apprehensions  and  distress, 
always  woke  after  a  few  hours'  sleep  in  a  wretched  state  of  panic 
fear,  so  that  he  could  not  get  to  sleep  again  but  was  obliged  to 
pace  the  room  in  an  agony  of  mind.  He  was  recommended  to 
take  when  he  awoke  a  cupful  of  beef-tea  with  a  little  sherry  or 
brandy  in  it,  and  then  to  lie  down  again ;  and  the  result  was 
that  he  got  to  sleep  and  soon  recovered,  afterwards  getting 
married  again,  old  as  he  was.  To  get  out  of  bed  and  walk  up 
and  down  the  room  a  few  times,  to  go  through  a  little  gymnastic 
exercise,  to  brush  the  hair  briskly,  to  sponge  the  body  with 
water  and  to  rub  it  well  afterwards  with  a  towel — are  expe- 
dients which  may  be  had  recourse  to;  instead  of  tossing  about 
in  bed ;  they  may  help  a  mild  sedative  to  take  effect  when  the 
person  gets  into  bed  again,  if  they  do  not  break  the  spell  of 
tormenting  ideas  and  enable  him  to  go  to  sleep  without  any 
sedative.  One  gentleman  who  consulted  me  used  to  get  into 
a  cold  bath,  and  found  that  efficacious. 

There  is  no  doubt  of  the  value  of  systematic  exercise  and 
employment  in  the  treatment  of  mental  disease.  If  one  could 
persuade  or  compel  a  strong  and  turbulent  maniac  to  plough  a 
field,  or  to  row  several  hours  a  day,  or  to  walk  twenty  miles  a 
day  for  a  month,  taking  plenty  of  nourishment  the  while,  the 
treatment  would  do  him  more  good  than  he  would  get  from  all 
the  drugs  of  the  Pharmacopoeia.  The  co-ordinated  use  of 
energy  in  any  sort  of  systematic  employment  is  an  excellent 
medicine  for  the  distracted  and  incoherent  mind.  Employment 
is  a  thing  therefore  to  be  patiently  and  persistently  aimed  at, 
albeit  it  may  be  very  difficult  to  get  it  done :  the  maniac  is 
oftentimes  too  turbulent  and  restless  to  fix  his  attention  for  any 
length   of  time ;  the  melancholic  too  self-indulgent  or  lacking 


564  PATHOLOGY  OF  MIND.  [chap. 

in  energy  to  make  what  is  to  him  a  painful  effoi-t  and  to  per- 
severe. In  enjoining  exercise  it  will,  of  course,  be  necessary  to 
have  attentive  regard  to  the  state  of  the  bodily  strength  and  to 
any  symptoms  of  bodily  disease,  and  to  modify  rules  accord- 
ino-ly  ;  in  the  most  acute  form  of  mania,  especially  in  acute 
delirious  mania,  the  patient  should  be  kept  as  quiet  as  possible, 
and  treated  more  as  a  person  suffering  from  meningitis  or  from 
the  delirium  of  fever  would  be  treated. 

The  general  medical  treatment  in  mental  disease  must  be 
based  upon  the  most  careful  appreciation  of  the  bodily  state. 
If  there  is  reason  to  believe  that  it  is  of  syphilitic  origin,  iodide 
of  potassium  should  be  given   freely,  and,  if  necessary,  some 
preparation  of  mercury.    Small  doses  of  the  chloride  of  mercury 
in  decoction  of  cinchona  answer  very  well.     It  is  remarkable 
how   rapid   and  complete   sometimes   is    the    change    for   the 
better  which  follows  the  administration  of  antisyphilitic  remedies 
to  a   patient  whose   demented   symptoms   seemed  to  portend 
certainly  an  incurable  insanity.     The  one  hope  for  an  obscure 
case   which,  presenting  most  of   the  features  of  commencing 
o-eneral  paralysis,  as  syphilitic  insanity  sometimes  does,  cannot 
be  diagnosed  with  certainty,  is  that  it  is  of  syphilitic  origin, 
since,  if  it  be,  there  is  a  fair  chance  that  recovery  will  take 
place  under  specific  treatment.     If  there  be  a  suppression  of 
the  menses,  as  there  often  is,  it  must  be  borne  in  mind  that  the 
insanity  most  frequently  causes  the  suppression,  not  the  sup- 
pression the  insanity.      No   good   therefore  will  be   done  by 
active  measures  to  provoke  menstruation  in  such  cases ;  on  the 
contrary,  if  such  measures  are  successful  and  the  menses  are 
regular  without  an  accompanying  change  for  the  better  taking 
place  in  the  mind,  the  prognosis  becomes  more  gloomy.     But  if 
they   return   naturally   as   the   mind    shows   definite  signs  of 
amendment,  then  there  is  good  hope  that  mind  and  body  will 
go  on  together  to  complete  recovery.     Sometimes,  however,  they 
remain   obstinately  suppressed    after  decided  improvement  or 
complete   restoration   of    mind.     In   that   case   I   have  found 
nothing  more   useful  than  an  ounce  of   a  mixture  containing 
equal  parts  of  Mistura  Ferri  Co.  and  Decoct.  Aloes  Co.,  taken 
early  every   morning.      Or   a  pill   containing   aloes   and  iron 


XI.]  THE  TREATMENT  OF  MENTAL  DISORDERS.  565 

may  be  given  every  night.  In  some  very  obstinate  cases  Dr. 
Savage  has  found  the  tincture  of  hellebore  in  doses  of  from 
half  a  drachm  to  a  drachm  two  or  three  times  a  day  to  be  very 
successful.  Obviously  in  a  case  in  which  the  menstrual  sup- 
pression and  the  mental  disease  appear  to  be  common  effects 
of  a  low  state  of  the  general  health  or  of  an  enfeebling  bodily 
disease,  the  proper  treatment  will  be  to  treat  the  constitutional 
state :  to  strengthen  the  weak  body  will  be  to  do  the  best  for 
the  functional  irregularity. 

In  many  cases  of  melancholia  and  in  some  cases  of  asthenic 
mania  cod-liver  oil  is  most  useful,  and  it  may  be  proper  to 
give  iron  and  quinine  also.  Among  tonics,  however,  I  have 
found  small  doses  of  arsenic  alone,  or  in  combination  with 
small  doses  of  strychnia,  to  be  of  the  greatest  service.  I  have 
more  faith  in  arsenic,  indeed,  than  in  phosphorus,  which  many 
persons  now  employ  largely  in  cases  of  nervous  depression.  In 
the  treatment  of  general  paralysis,  physostigma,  the  active  prin- 
ciple of  the  calabar  bean,  has  been  employed  by  Dr.  Crichton 
Browne,  at  the  West-Eiding  Asylum,  with  alleged  results 
which,  having  regard  to  the  generally  accepted  notion  of  the 
incurable  nature  of  the  disease,  must  be  accounted  extraordi- 
narily successful.  Other  experimenters  have  not  yet  had  the 
successes  which  he  has  had  from  its  use,  and  further  observa- 
tions are  required  in  order  to  settle  what  its  actual  value  is. 
It  may  be  given  when  given  in  doses  of  twenty  drops  of  a 
Tincture  or  of  from  yV  to  i  of  a  grain  of  the  Extract. 

Let  it  not  be  forgotten  that  a  cheerful  and  hopeful  mood  of 
mind  is  a  most  valuable  remedy  against  disease  of  all  sorts,  and 
that  if  the  physician  can  infuse  that  into  the  patient  he  will 
often  do  him  more  good  than  by  all  infusions  of  drugs. 
Charms,  amulets,  ceremonies,  and  the  like,  which  have  prevailed 
amongst  all  nations  in  all  ages,  have  without  doubt  been  truly 
helpful  in  curing  disease,  having  owed  their  efficacy  to  the 
faith  and  hope  which  they  inspired.  Hope  inspires  the  organic 
elements  of  the  body  with  energy ;  despair  infects  them  with 
feebleness.  If  a  person  is  convinced  he  will  die  of  a  disease 
from  which  he  is  suffering,  and  abandons  himself  to  despair, 
he  will  die  when  there  was  not  death  in  the  disease ;  if  he  is 


5G6  PATHOLOGY  OF  MIND.  [chap.  xi. 

convinced  that  he  will  not  die,  and  looks  forward  buoyantly  to 
recovery,  he  will  hold  death  successfully  at  defiance  even  when 
its  victory  seems  assured.  In  like  manner  recovery  from 
chronic  disease  will  take  place  when  the  organic  functions  feel 
the  animation  of  a  hopeful  spirit,  whereas  the  disease  may 
continue  or  even  increase  if  they  are  oppressed  with  the  weight 
of  despondency.  He  is  commonly  the  best  physician  who 
inspires  the  most  faith  in  his  patient. 

In  conclusion — and  it  may  well  be  the  last  word  concerning 
treatment — the  physician  cannot  too  constantly  and  sincerely 
bear  in  mind  that  the  body  is  not  a  mechanism  the  parts  where- 
of work  independently  of  one  another  and  may  be  adjusted  to 
their  special  purposes  without  relation  to  the  purpose  of  the 
whole,  but  a  living  organism,  each  part  of  which  calls  the 
furthest  brother,  and  no  part  of  which  can  suffer  or  be  glad 
without  the  whole  suffering  or  being  glad  with  it,  the  humblest 
element  working  in  the  whole  and  the  whole  in  the  humblest 
element.  Keeping  this  just  conception  ever  in  mind,  he  shall 
not  miss  the  practical  lesson  of  it :  namely,  that  he  should 
strive  always  to  bring  the  inspiration  of  a  healthy  tone  of  mind 
to  bear  upon  the  disorders  of  the  body,  and  should  not  ever 
neglect  to  observe  and  to  put  right  the  meanest  bodily  disorder 
in  his  efforts  to  restore  health  to  the  disordered  mind.  Let  him 
pass  reverently  through  a  holy — i.e.  healthy — temple  of  the 
body  to  the  inner  sanctuary  of  a  holy  temple  of  mind. 


^ 


INDEX. 


25 


INDEX. 


A. 


Abdomen,  disease  of,  as  cause  of  in- 
sanity, 211,  212,  238,  521. 

Abstraction,  the  state  of  mental,  55. 

Aconite,  poisonous  etfects  of,  36,  368. 

Action,  in  the  formation  of  character, 
161. 

Age,  its  influence  in  heredity,  119, 
120  ;  decay  of  old,  120,  475  ;  its  in- 
.  fluence  in  insanity,  167,  168,  238. 

Agoraphobia,  319,  431. 

Ague,  as  cause  of  insanity,  200. 

Albers,  Professor,  on  the  use  of  a  pro- 
longed cold  bath,  544. 

Alcohol,  the  effects  of,  194,  195,  398. 

Alcoholism,  acute,  484  ;  chronic,  485. 

Alternation,  of  sanity  and  insanity, 
412  ;  of  mania  and  melancholia, 
352,  394,  412. 

Ambition,  the  vanity  of,  159,  160  ;  a 
contemptible  social,  170 ;  disap- 
pointed, 222. 

Amenorrhoea,  treatment  of,  564,  565. 

Amentia,  326. 

Amyloid  bodies,  512,  513. 

Ancestors,  latent  qualities  of,  90. 

Aneurisms,  miliary,  472,  516. 

Animals,  mesmeric  experiments  on, 
54  ;  acute  perceptions  of,  69 ;  man's 
community  of  nature  with,  116, 
117  ;  insanity  of,  260,  261. 

Antisocial  beings,  100  —105,  115,  524. 

Apoplexy,  predisposing  to  insanity, 
110,  111  ;  in  old  age,  120. 

Appetites,  perverted,  427. 

Arago,  his  attempt  to  overthrow  an  in- 
sane delusion,  538. 


Aretoeus,  206. 

Aristocracy,  the,  insanity  among,  170. 

Aristotle,  on  the  melancholy  of  great 

men,  245. 
Armenians,  the,  151. 
Arsenic,  in  melancholia,  565. 
Arteries,  atheroma  of,  472. 
Ascaris  lumbricoides,    unusual   symp- 
toms caused  by,  208. 
Ascetic,  the  religious,  243. 
Assertion,  the  influence   of  confident, 

56. 
Asthma,   its    neurotic  relations,    107, 

108. 
Asylums,    the   propriety   of  treatment 

in,  525  ;  public  and  private,   526 — 

530. 
Atavism,  93. 
Atheroma,  472. 
Atkins,  Dr.  Eingrose,  on  the  morbid 

appearances  in  acute  mania,  505. 
Atmosphere,    effects   of  states   of,    48, 

49. 
Attendants  on  the  insane,  534,  540. 
Aura  epileptica,  the,  447. 
Austi'alian,  the  native,   inferior  brain 

of,  89. 
Automatism,  of  ideas  and  feelings,  69  ; 

of  action,  74,  223. 
Aveyron,  the  savage  of,  178. 
Azam,  on  the  mental  efiects  of  uterine 

disease,  208. 


B. 


Baee,  von,  176. 

Baillarger,      on      delirium     following 
dreaming,    40,    41 ;    on    arrest    of 


INDEX. 


growth  in  idiocy,  180  ;  on  an  at- 
tempt to  overthrow  an  insane  delu- 
sion, 538. 

Baths,  in  the  treatment  of  insanity, 
543—545. 

Bayle,  on  the  resemblance  between 
drunkenness  and  general  paralysis, 
443. 

Belief,  enforced,  56  ;  influence  of  tem- 
perament on,  65  ;  influence  of  faith 
on,  79  ;  real  and  professed,  134 ;  in 
the  supernatural,  137  ;  the  ordinary 
foundations  of,  539. 

Belladonna,  hallucinations  caused  by, 
375, 

Billroth,  on  a  gelatinous  degeneration 
of  the  cerebellum,  515, 

Blake,  William,  his  hallucinations, 
268. 

Blood,  the,  efl'ects  of  quality  of,  upon 
dreams,  41  ;  the  circulation  of,  in 
idiocy,  480 ;  the  influence  of,  upon 
mind,  188 — 205  ;  the  efl'ects  of  viti- 
ated, 194  ;  poverty  of,  198. 

Blood-letting,  in  the  treatment  of  in- 
sanity, 542. 

Blumenbach,  on  the  state  of  the  brain 
during  sleep,  3. 

Body,  the,  arrested  growth  of,  in 
idiocy,  180,  181. 

Bohemia,  Agnes  of,  35. 

Bowels,  state  of,  in  melancholia,  378. 

Braid,  Mr.,  his  hypnotic  experiments, 
37,  38,  53. 

Brain,  the — state  of,  during  sleep,  3 ; 
during  dreaming,  4  ;  effects  of  pres- 
sure on,  8,  9  ;  the  unconscious  action 
of,  15—17;  syphilis  of,  109,  110, 
235,  506  ;  cancer  of,  109,  110,  234  ; 
inferior  type  of,  175  ;  the  microce- 
phalic, 176;  arrested  development 
of,  177—180  ;  the  influence  of  blood 
upon,  188 — 205  ;  congestion  of,  189, 
502  ;  anaemia  of,  191,  198,  501  ; 
irritation  of,  192  ;  organic  disease 
of,  217 ;  excessive  function  of,  219  ; 
injuries  of,  226,  227 ;  tumour  of, 
231  ;  abscess  of,  231,  235 ;  cysiicer- 
cus  of,  234,  235 ;  loss  of  substance 
of,  235  ;  an  excess  of  serum  in  ven- 
tricles of,  289  ;  disordered  circulation 
in,  498—502;  morbid  changes  in, 
502 — 519  ;  hypersemia  of,  510  ;  the 
so-called  hypertrophy  of,  515. 

Brown,  Dr.  Crichton,  on  the  insanity 
of  early  life,  276  ;  on  the  calabar 
beau  in  general  paralysis,  565. 


Brunet,  on  hypertrophy  of  the  brain, 
516. 

Bucknill,  Dr.  J.  C,  on  counter-irrita- 
tion in  the  treatment  of  insanity, 
5i6. 

Buddha,  self-sacrifice  of,  140. 

Burdach,  94. 

Burrows,  Dr.,  on  diff"erent  pulses  in  the 
carotid  arteries,  190  ;  on  sympathetic 
mania,  207  ;  on  the  transformation 
of  nervous  diseases,  230  ,  on  homi- 
cidal impulse  in  epilepsy,  339. 

Bushman,  the,  brain  of,  175. 


C. 


Cabanis,  on  the  senses  in  somnam- 
bulism, 62. 

Calabar  bean,  the,  in  the  treatment  of 
general  paralysis,  565. 

Cameron,  Commander,  his  journey 
across  Africa,  128. 

Capillaries,  diseased,  511 ;  the  second- 
ary sheaths  of,  512. 

Carbonic  acid,  effects  of  inhalation  of, 
189,  490. 

Carotid  arteries,  the,  the  pulses  in, 
190  ;  the  effect  of  tying,  192. 

Casaubon,  522. 

Cases,  notes  of,  illustrating  causation 
of  insanity,  249 — 255. 

Catalepsy,  56,  73. 

Celibacy,  an  effect  of,  136. 

Cerebellum,  the,  the  laminae  of,  176 ; 
gelatinous  degeneration  of,  515. 

Cerebral  circulation,  the,  during  sleep, 
3  ;  during  dreaming,  39 — 43  ;  partial 
irregularities  of,  193  ;  disordered, 
498—502. 

Character,  the  moral  development  of, 
154,  155, 161 ;  effects  of  sectarianism 
on,  150  ;  the  formation  of  a  strong, 
159,  161,  163;  differentiations  of, 
306. 

Childhood,  the  dreams  of,  47  ;  the  in- 
sanity of,  256 — 295  ;  the  nightmare 
of,  263  ;  incoherence  of,  265  :  falla- 
cious memory  of,  265  ;  the  imagina- 
tion of,  269  ;  suicide  of,  279. 

Children,  of  deficient  intellect,  288. 

China,  insanity  in,  131. 

Chloral,  the  hydrate  of,  in  the  treat- 
ment of  insanity,  552 — 554,  556 — 
558. 

Chorea,  108,  2G9  ;  as  cause  of  insanity, 
228. 


INDEX. 


571 


Church  of  Kngl.mcl,  the,  148. 

Church  of  Koine,  the,  136,  144. 

Civilisation,  its  efl'ects  ou  the  increase 
of  insanity,  127 — 135  ;  the  puisuits 
of  modern,   133. 

Claike,  Dr.  Lockhart,  on  granulations 
of  the  ventricles,  506  ;  on  the 
secondary  sheaths  of  the  cainllaries, 
512  ;  on  pigmentary  degeneration  of 
nerve-cells,  517. 

Classificfttion,  the,  of  insanity,  296, 
297,  326—329,  439. 

Climacteric  change,  the,  168,  469, 

Clouston,  Dr.,  on  phthisis  and  in- 
sanity, 112,  620  ;  on  opium  in  the 
treatment  of  insanity,  554  ;  on  can- 
nabis indica,  560. 

Coleridge,  S.  T.,  on  dream-images,  24; 
on  nightmare,  29 ;  on  fancy  and 
imagination,  269. 

Coleridge,  Hartley,  phantasms  of,  268. 

Colloid  corpuscles,  512. 

Colon,  the,  a  displacement  of,  521. 

Communion,  social,  157 ;  religious, 
157. 

Conception,  slowness  of,  494. 

Confessional,  the  effects  of,  144. 

Conium,  the  juice  of,  in  the  treatment 
of  insanity,  560. 

Conjuror,  the,  his  tricks,  77. 

Connective  tissue,  the,  of  brain,  in- 
crease of,  511,  515. 

Consanguinity,  marriages  of,  95,  120 — 
126. 

Conscience,  loss  of,  in  dreaming,  11 ; 
exaggerated  sensibility  of,  143 ; 
among  savages,  129  ;  a  sanitary, 
155  ;  a  completely  developed,  156  ; 
varieties  of  social,  161. 

Consciousness,  a  peculiar  phenomenon 
of,  28 ;  a  probable  law  of,  58  j  a 
state  of  abnormal,  75 — 77. 

Consensus,  the  physiological,  521. 

Conservatism,  the,  of  savages,  129. 

Constitution,  how  to  change  a,  123. 

Convolutions,  cerebral,  simplicity  of, 
175,  178  ;  the  layers  of,  183. 

Convulsions,  infantile,  257 ;  co-ordi- 
nate, 259. 

Cooper,  Sir  Astley,  on  the  effects  of 
tying  the  carotid  arteries,  192. 

Corpora  amylacea,  512. 

Corpus  callosum,  the,  absence  of,  178. 

Cottages,  the  insane  in,  534. 

Counter-irritation,  in  the  treatment  of 
insanity,  546. 

Cousins,  intermarriage  of,  123,  124. 


Cox,    Dr.    ]\rason,    on  the  radial  and 

carotid  pulses,  190. 
Craziness,  327,  427. 
Crime,  103—105  ;  unscientific  view  of, 

138. 
Criminals,  classes  of,  104. 
Cynicism,  99. 
Cysticercus,  217. 
Czermak,     mesmeric    experiments    on 

animals,  54. 


D. 


Dagonet,  on  homicidal  impulse,  337. 

Damnation,  delusion  of  eternal,  146, 
361,  385. 

Dancing  mania,  73. 

Darwin,  Dr.  Erasmus,  on  the  dreams 
of  a  deaf  person,  22  ;  on  the  trans- 
formation of  nervous  diseases,  218, 
229. 

Darwin,  Charles,  on  the  cross-fertili- 
sation of  plants,  122. 

Darwin,  George,  on  marriages  of  con- 
sanguinity, 120, 

Datura  stramonium,  poisonous  effects 
of,  263,  414. 

Deaf-mutism,  125. 

Death,  Christian  and  Pagan  views  of, 
145  ;  cause  of,  in  melancholia,  394, 
395  ;  cause  of,  in  mania,  414,' 415  ; 
cause  of,  in  general  paralysis,  442, 
443 ;  caused  by  chloral  hydrate, 
557, 

Deception,  deliberate,  64,  77  ;  self- 
deceiving,  64,  78,  149  ;  of  the  in- 
sane, 536, 

Degeneracy,  human,  104,  105,  113 — 
117,  290—295  ;  theroid,  293  ;  bodily 
signs  of,  322. 

Dehumanisation,  the  process  of,  294, 
295, 

Delire  aigiie,  405,  406. 

Delirium,  of  cerebral  hypersemia,  39  ; 
of  cerebral  anaemia,  39  ;  acute,  405, 
40G  ;  of  fever,  204  ;  sympathetic, 
208  ;  of  tumour  and  abscess  of  the 
brain,  232  ;  tremens,  484,  485. 

Delirium  tremens,  its  rareness  among 
savages,  128  ;  acute,  484  ;  chronic, 
485. 

Delusion,  insane,  486  ;  the  mode  of 
development  of,  2u2,  205,  211,  225, 
240,  258,  360  ;  the  growth  of,  203  ; 
the  removal  of,  203,  240,  530  ;  the 
infection  of,  309 ;  of  persecution, 
389 ;  of    suspicion,    390  ;    of  gran- 


572 


INDEX. 


deur,  439  ;  the  itselessness  of  argu- 
ment  against,  537. 

Dementia,  326;  senile,  168,  473  — 
476,  516  ;  temporary  recovery  from, 
during  fever,  190  ;  symptomatology 
of,  425—431 ;  acute,  429,  430  ;  of 
general  paralysis,  441  ;  of  epilepsy, 
448  ;  of  insanity  of  self-abuae,  459  ; 
alcoholic,  486;  morbid  changes  in, 
515,  516. 

Despair,  the  depressing  effects  of,  565. 

Development,  stages  of  embryonic, 
116. 

Diabetes,  in  insane  families,  113. 

Diaboleptics,  71. 

Dialectical  Society,  the,  80. 

Diet,  the,  in  insanity,  547,  548. 

Differentiations,  of  constitution,  122, 
123,  126,  306. 

Digitalis,  in  the  treatment  of  insanity, 
558. 

Dipsomania,  107,  108,  487,  488. 

Disease,  foreboded  by  dreams,  42 ; 
caused  by  ideas,  68  :  the  causation 
of,  85  ;  not  a  morbid  entity,  172  ; 
metastasis  of,  201  ;  inhibition  of, 
201,  210  ;  functional  and  organic, 
218  ;  ascopic  changes  in,  491  ;  mi- 
croscopic changes  in,  491  ;  macro- 
scopic changes  in,  491. 

Dissent,  religious,  148. 

Dogs,  hallucinations  in,  261. 

Dreaming,  7 — 49 ;  time  of,  9  ;  resem- 
blance of,  to  insanity,  9,  10,  24,  30; 
volition  in,  10,  11  ;  personal  identity 
in,  11 ;  absence  of  surprise  in,  12  ; 
the  images  of,  13,  24 ;  the  charac- 
teristic features  of,  14;  the  imagin- 
ation in,  15  ;  achievements  in,  18  ; 
the  dramatic  power  in,  18  ;  memory 
in,  18 — 21 ;  the  causes  and  condi- 
tions of,  21 — 48  ;  by  a  deaf  person, 
22;  Coleridge  on  the  images  of,  24;  an 
interpretation  of,  26  ;  impressions  on 
senses  in,  28 — .30,  58 ;  the  experi- 
mental production  of,  28,  29  ;  or- 
ganic impressions  in,  29 — 35  ;  effects 
of  visceral  organs  upon,  33,  34 ;  the 
effects  of  muscular  sensibility  upon, 
35—39  ;  of  falling,  37  ;  of  flight, 
38  ;  effects  of  cerebral  circulation  on, 
39—43  ;  vivid,  39  ;  followed  by  de- 
lirium, 41  ;  the  effects  of  quality  of 
blood  upon,  41  ;  foreboding  disease, 
42 ;  effects  of  nervous  exhaustion 
upon,  44,  46 ;  in  old  age,  46 ;  in 
childhood,   47,  48  ;  effects  of  atmo- 


spheric states  upon,  48,  49  ;  the  me- 
dical significance  of,  49. 

Durham,  A.,  on  the  brain  during  sleep, 
3. 

Durand  Fardel,  on  suicide  by  children, 
2r9. 


E. 


Ear,  the  malformation  of,  322  ;  the 
asylum  or  insane,  384. 

Eccentricity,  100,  297,  298. 

Echeverria,  Dr.  M.  G.,  on  the  use  of 
the  trephine  in  epilepsy,  547. 

Eclipse,  the  race-horse,  121. 

Ecstasy,  70 ;  the  phenomena  of,  71  ; 
holy  and  demoniacal,  71  ;  memory 
in,  73  ;  trances  of,  144  ;  insane,  459. 

Education,  limits  of  power  of,  89  ;  and 
insanity,  152 — 164  ;  the  true  basis 
of,  153;  the  ideal  of,  160,  163;  the 
bad  system  of  female,  163. 

Egotism,  100—102. 

Electricity,  in  nerves,  494. 

Emotion,  wise  and  unwise  cultivation 
of,  141 — 144  ;  the  wear  and  tear  of, 
169,  170,  219  ;  the  physical  basis  of, 
222. 

Employment,  of  the  insane,  537,  563. 

Energy,  kinds  of,  411. 

Enthusiasm,  bodily  effects  of,  72,  73  ; 
kindlmg  of,  157  ;  prophetic,  446  ;' 
infection  of,  539. 

Environment,  the,  adaptation  to,  85, 
98  ,  99,  173  ;  the  influence  of  the 
social,  160,  161. 

Epidemics,  moral,  158. 

Epilepsy,  automatic  action  in,  74 — 77  ; 
a  peculiar  case  of,  75  ;  resemblance 
to  somnambulism,  76  ;  predisposing 
to  insanity,  107,  108;  a  cause 
of  idiocy,  179  ;  a  cause  of  insanity, 
228,  273  ;  furious  mania  of,  261  ; 
masked,  274  ;  homicidal  impulse  in, 
338 — 341  ;  moral  insanity  in,  353  ; 
a  suggestion  of  mental,  365  ;  hallu- 
cinations of,  445,  446  ;  the  religious 
feeling  in,  445  ;  monomania  of,  445. 

Erotomania,  344. 

Esquirol,  on  hereditary  transmission, 
117  ;  on  menstruation  and  insanity, 
197  ;  on  sympathetic  delirium,  208  ; 
on  abdominal  disease  in  insanity,  21 2; 
on  loss  of  sensibility  of  skin,  215  ; 
on  phases  of  insanity,  239  ;  cases  of 
insanity  in  children,  283,  284 ;  on 
the  marks  of   an   insane  heredity, 


INDEX. 


573 


320 ;  his  classification  of  mental 
diseases,  327  ;  on  moral  alienation, 
328  ;  monomauie  raisonnante,  355  ; 
a  case  of  auditory  liallucinations, 
374  ;  on  convalescence  from  insanity, 

-  404  ;  ou  lypemania,  416  ;  on  three 
forms  of  monomania,  416 ;  on  dis- 
placement of  the  colon,  521. 

Etiology,  of  insanity,  83 — 174. 

Eunuchs,  the  moral  character  of,  45-1. 

Evangelicalism,  149. 

Evolution,  the  aim  of,  98 — 100. 

Experience,  influence  on  dreams,  21 — - 
27  ;  reversions  to  ancestral,  27. 


F. 


Faculties,  mental,  superior  natural, 
188,  189;  the  right  cultivation  of, 
188. 

Faith,  power  of,  79,  566 ;  real  and 
professed,  134. 

Family,  an  insane,  309  ;  sympathetic 
feeling  of,  306,^  311. 

Faria,  the  Abbe,  his  mode  of  mes- 
merism, 54. 

Fatuity,  327,  429. 

Features,  peculiarities  of,  321 ;  in  in- 
sanity, 403  ;  in  acute  mauia,  409. 

Feeding,  the  necessity  of  forcible,  409, 
410. 

Feeling,  insanity  of,  328,  329  ;  dege- 
neration of  social,  100 — 105,  347  ; 
the  religious,  in  epilepsy,  445. 

Feigning,  of  disease,  324. 

Fetish,  the  belief  in  a,  138—140,  149. 

Fever,  its  eifects  on  mental  derange- 
ment, 190  ;  a  cause  of  mental  de- 
rangement, 201 ;  the  delirium  of, 
204  ;  failure  of  memory  after,  414. 

Folie  circulaire,  352,  412. 

Food,  refusal  of,  in  melancholia,  379 ; 
in  mania,  409. 

Foville,  Dr.  A,,  on  the  general  impair- 
ment of  mind  in  monomania,  423. 

Frenzy,  the  prophetic,  397,  446. 

Function,  excess  of,  219 ;  structurali- 
sation  of,  223,  489. 


G. 


Galen,  200. 

Galton,  F.,  on  hereditary  genius,  96, 

118. 
General  paralysis,   225;    disorders  of 


organic  sensibilities  in,  369  ;  symp- 
tomatology of,  432 — 444  ;  causes  of, 
433 — 435  ;  varieties  of,  441  ;  the 
course  of,  442,  443  ;  cause  of  death 
in,  443 ;  morbid  changes  in,  507, 
511,  512,  517. 

Genius,  non-inheritance  of,  96 ;  Mr. 
Galton  on  hereditary,  95,  118. 

Ghosts,  visions  of,  25. 

God,  the  belief  in,  140,  141. 

Goethe,  299,  301,  304. 

Goltz,  experiment  on  frog,  194. 

Gout,  as  cause  of  insanity,  111,  197  ; 
occurrence  of,  120. 

Governesses,  their  supposed  liability  to 
insanity,  169. 

Gratiolet,  125,  126. 

Gravitation,  the  law  of,  156, 173. 

Gregory,  Dr.,  on  hallucination  preced- 
ing epilepsy,   447. 

Griesinger,  on  ague  as  cause  of  in- 
sanity, 200  ;  on  rheumatic  insanity, 
201  ;  on  sympathetic  insanity,  207  ; 
on  the  mental  effects  of  pregnancy, 
209 ;  on  anomalies  of  sensibility, 
216 ;  a  case  of  cataleptoid  insanity, 
275  ;  homicidal  epileptic  mania,  340; 
intermissions  in  melancholia,  366. 

Guislain,  209  ;  on  mania  generated  by 
intemperance,  182  ;  a  case  of  mania 
from  caries  of  nose,  276. 

Gnmmata,  syphilitic,  200,  481,  482, 
609. 


H. 


Habit,  the  formation  of,  86,  224  ;  the 
tyranny  of,  303. 

Hfematoidin,  granules  of,  512. 

Hsematoma  auris,  384. 

Hair,  the,  in  melancholia,  378 ;  in 
mania,  409. 

Hallucinations,  of  movements,  35,  36, 
78,  79,  215,  399;  sympathetic,  207; 
sexual,  211  ;  in  dogs,  261  ;  in  in- 
fants, 263 ;  in  children,  267  ;  their 
modes  of  production,  266,  267,  372 
— 376  ;  in  melancholia,  371 — 377  ; 
in  mania,  399  ;  in  epilepsy,  445 — 
447  ;  in  the  insanity  of  self -abuse, 
459  ;  in  delirium  tremens,  484 ;  in 
chronic  alcoholism,  485. 

Hamilton,  Sir  W.,  on  perception  by 
somnambulists,  62. 

Haslam,  case  of  insanity"  in  a  young 
child,  282  ;  a  case  of  moral  insanity, 
286. 


574 


INDEX. 


Hearing,  hallucinations  of,  371 — 376. 
Heart,  the,  sleep  of,  1  ;  exhaustion  of, 
2  ;   iutermittence  of,    378  ;   diseases 
of,  in  the  insane,  520. 
Heberden,  210. 

Hellebore,  549  ;  in  amenorrhcea,  565. 
Helmholtz,  on  the  time-rate  of  conduc- 
tion of  nerves,  492. 
Herbert,  George,  quotation  from,  212. 
Heredity,  87 — 106  ;  law  of  reproduction 
in,  88 — 91  ;  law  of  variation  in,  91 — 
93,  97  ;  morbid,  106—120, 186,  291, 
337,    338—343,    350;    statistics   of 
morbid,   106,    107,   117 ;   degrees  of 
morbid,  107  ;  the  influence  of  sex  in, 
117  ;  the   influence  of  age  in,   119, 
120 ;     in    deaf-mutism,     125 ;     the 
marks  of  morbid,  320—323. 
Heschl,  on  ossification  of  nerve-cells, 

518. 
Hippocrates,  123,  191,  206. 
Hobbes,  on  association  of  ideas,  13. 
Holland,    Sir   H.,    a   case  of  auditory 
hallucination,    372 ;  on   slowness  of 
conception  and  volition,  494. 
Homicide,  during  somnambulism,  81  ; 
in  insanity,  332—335,  365,  389-393  ; 
behaviour  after,  343,  392  ;  in  demen- 
tia, 428  ;  in  epilepsy,  447. 
Hope,  the  inspiring  effects  of,  565. 
House  of  Commons,  the,  Committees 

of,  523,  524. 
Howden,  Dr.,  on  the  religious  senti- 
ment   in    epileptics,    445  ;    on   the 
morbid  changes  in  senile  dementia, 
516. 
Howe,  Dr.,  on  intemperance  as  a  cause 

of  idiocy,  181. 
Hoy,  Dr.,  on  the  effects  of  pressure  on 

the  brain,  8,  9. 
Humanisation,   the   progress   of,    102, 

174. 
Humour,  99. 
Hunter,  John,  on  organic  sympathies, 

211. 
Hydrocyanic  acid,  in  the  treatment  of 

insanity,  561. 
Hydropathic  houses,  532. 
Hydrophobia,      morbid     changes    in, 

514. 
Hyoscyamus,  in  the  treatment  of  in- 
sanity, 558. 
Hypnotism,  50 — 61  ;  surgical  opera- 
tions in,  52  ;  conduct  during,  52  ; 
isolation  of  ideas  in,  57  ;  memory  in, 
57  ;  after  effects  of,  59,  60  ;  physical 
causes  of,  60, 


Hypochondriasis,  107,  120  ;  of  great 
men,  245  ;  of  melancholia,  370,  471. 

Hypocrisy,  unconscious,  149,  150,  308. 

Hysteria,  107,  108,  324  ;  as  cause  of 
insanity,  228  ;  mental,  323,  461 ; 
reflex  action  in,  498. 


I. 


Ideas,  the  association  of,  13, 15  ;  their 
inverse  relation  to  movements,  32  ; 
isolation  of,  57 ;  effects  of  precon- 
ceived, 67  ;  disease -producing,  68  ,• 
organisation  of,  265  ;  abnormal  ex- 
citation of,  359 ;  greatly  elated, 
439. 
Idiocy,   the  brain  in,   176 — ISO  ;  the 

causes  of,  181,  182. 
Idiosyncrasy,  214,  236. 
Idiots,   sterility  of,  95  ;  the  brains  of, 
176 — 180;  on  morbid  changes  in  the 
brains  of,  514,  515. 
Imagination,  the,  in  dreaming,  15,  21; 
in  reverie,   15  ;  in  childhood,  209  : 
one-sided,  303. 
Imbecilitv,     intellectual,     288,     344 ; 

moral,  289— 291,  318,  344,  350. 
Imposture,    deliberate,    64,    77 ;     self- 
deceiving,  67,  78. 
Impulses,  morbid,  76  ;  homicidal,  279, 
333,  338—346,   362,   459;  suicidal, 
279,   332,   338,   362,    389,    459  ;   to 
steal,  290  ;  to  vice  and  crime,  290  ; 
ridiculous   morbid,    312—317,    344, 
355  ;  predisposing  conditions  of,  337. 
Individuality,  the  foundation  of,  88  ; 

J.  S.  Mill  on,  298.  _ 
Infant,  first  perceptions  of,  257  ;  in- 
sanity of  an,  258  ;  hallucinations  in 
the,  263. 
Infection,  mental,  158  ;  putrid,  199. 
Inflammation,  the  early  stages  of,  491, 

499. 
Inhibition,  cerebral  phenomena  of,  55  ; 
suspension  of,  402,  411  ;  vasomotor, 
193  ;  of  one  disease  bv  another,  201, 
210,  230. 
Insanity,  causation  of,  83 — 255  ;  etio- 
logical causation  of,  83 — 174  ;  path- 
ological causation  of,  175 — 236  ;  co- 
operation of  causes,  84  ;  physical  and 
moral  causes  of,  85  ;  generation  of 
predisposition  to,  9S,  97,  102,  124, 
134;  neutralisation  of  a  predispo- 
sition to,  97,  164  ;  the  fundamental 
me.aning  of,    98  —100 ;  its  affiuities 


INDEX. 


575 


to  crime,    103 — 105  ;  scrofula  anrl, 
111,    gout  and,    111  ;  phthisis  and, 
112;  diabetes  and,   113;  hereditary 
transmission    of,     117 — 120;    inter- 
marriasjes   as   cause    of,     120 — 126  ; 
civilisation   and,    127 — 135  ;   statis- 
tics of,  131,   165  ;  religion  as  cause 
of,  135 — 152  ;  education  and,  152 — 
164 ;    the    scientitic   view   of,    158  ; 
moral   causes   of,    159  ;  influence  of 
sex  on,   164 — 167  ;  influence  of  age 
on,  167  ;  influence  of  occupation  on, 
168  ;  a  proof  of  weakness,  173  ;  re- 
covery during  fever  in,  190  ;  of  oxa- 
luria,    199  ;  pellagrous,    199  ;  inter- 
mittent, 200  ;  post-febi-ile,  201,  204; 
sympathetic,  207,  208  ;  of  preguanc}^ 
209  ;  puerperal,  209,  466—469  ;  cli- 
macteric,    210,    469 — 472  ;    uterine 
and  ovarian,   211  ;  phthisical,    213, 
477 — 480  ;  the  moral  causes  of,  220 
225 ;    from    injury    to   brain,    227  ; 
hvsterical,  228,  463—466  ;  epileptic, 
228,     261,    273  —  276,      444—449; 
moral,      229,     285  —  288,      344  — 
355  ;  cause  of  special  forms  of,  236 
240  ;  common  quality  of,   240  ;  the 
medical  and  legal  views  of,  246,  247; 
of  early  life,    256  —295  ;    sensorial, 
260—265  ;    choreic,    263—265,    270 
—272  ;  cataleptoid,  272,  273  ;  affec- 
tive,   277—292,  329—353  ,  instinc- 
tive, 280—285,  330—344  ;  the  symp- 
tomatology of,  296  ;  the  infection  of, 
309—311  ;  the  classification  of,  296, 
326 — 329  ,  characters  of  hereditary, 
350,  419,  420  ;  of  pubescence,  449— 
452;  of  self-abuse,  452 — 463  ;  amen- 
orrhoeal,  465  ;  hypochondriacal,  47lj 
senile,   472 — 477  ;  syphilitic,   480 — 
483,  564  ;  alcoholic,  483—488  ;  mor- 
bid changes  in,  502 — 521 ;  the  moral 
and  medical  treatment  of,  522 — 5QQ. 

Insensibility,  from  drowning,  8  ;  from 
injury  to  the  head,  8,  9 ;  during 
mental  abstraction  and  excitement, 
55,  73  ;  during  religious  exaltation, 
72,  73  ;  in  catalepsy,  74  ;  from  liga- 
ture of  the  carotid  arteries,  192  ;  from 
inhalation  of  carbonic  acid,  189. 

Insolation,  effects  of,  227. 

inspiration,  303. 

Instincts,  259  ;  insanity  of,  280 — 285, 
293  ;  of  self-conservation,  281  ;  of 
propagation,  283, 

Intellect,  the,  developed  out  of  sensa- 
tion and  motion,  17. 


Intemperance,  a  cause  of  idiocy,  181, 
182  ;  mania  caused  by,  1&2;  convul- 
sions caused  by,  182. 

Interbreeding  the  effects  of,  95,  120 — 
126. 

Intermittence,  of  cerebral  sjinptoms, 
232—235  ;  of  melaucholla,  866  ;  of 
mania,  411  ;  of  gtiieral  paralysis, 
442. 

Intervals,  lucid,  411. 

Introspection,  evils  at,  143, 

Irving,  Edward,  insanity  of,  416. 

Israel,  a  proverb  in,  88, 


J. 


Jackson,  Dr.  Hughlings,  on  syphilitic 

neuritis,  481. 
Jeffrey,   Lord,  his  mental  wanderings 

before  death,  46,  47. 
Jesus    Christ,    the   delusion   of  being, 

418,  424. 
Jews>  the,  151 . 


K. 


KiscHER,  mesmeric  experiments,  54. 

Kiss,  the  holy,  144. 

Kleptomania,  290,  344. 

Kolk,  Schroeder  Van  der,  on  phthisis 
and  insanity,  112  ;  on  sympathetic 
insanity,  207,  208  ;  on  the  morbid 
changes  in  insanity,  t03,  on  acute 
pachymeningitis,  508  ;  on  pigment- 
ary degeneration  of  nerve-cells,  517; 
on  counter-irritation  in  the  treatment 
of  insanity,  546. 


L. 


Lactation,  insanity  of,  209,  46S. 

Lallemand,  on  the  mental  effects  of 
spermatorrhoea,  338. 

Lamb,  Charles,  on  the  sanit}'  of  true 
genius,  301. 

Larrey,  Baron,  case  of  morbid  sym- 
pathy, 207. 

Lateau,  Louise,  71. 

Laughter,  convulsive,  259,  264. 

Laurent,  on  svmpathetic  delirium,  208. 

Law,  the  reign  of,  135,  138,  139,  146, 
256  ;  physical  and  moral,  157  j  the 
infraction  of,  157. 

Lawson,  Dr.,  on  hyoscyamine  in  the 
treatment  of  insanity,  559. 


576 


INDEX. 


Lead  palsy,  196. 

Lebert,  Prof,,  on  abscess  of  the  brain, 
231. 

Lee,  Anne,  the  visions  of,  446. 

Leidesdort,  Dr.,  ou  a  prolonged  bath, 
543. 

Leucocythgemia,  199. 

Liebreich,  on  retinitis  pigmentosa,  517. 

Life,  the  change  of,  168,  469. 

Lister,  on  the  early  stages  of  inflam- 
mation, 491,  499. 

Locke,  John,  on  the  moral  effects  of 
the  love  of  riches,  161  ;  on  the  right 
use  of  natural  faculties,  188  ;  on  tho 
reasoning  of  a  lunatic,  422  ;  on  the 
time-rate  of  mental  functions,  493. 

Love,  the  holy  kiss  of,  144  ;  ecstasies 
of,  144. 

Lucas,  Dr.  Prosper,  94. 

Lung,  the,  gangrene  of,  395,  519. 

Luther,  his  interview  with  tlie  devil, 
24. 

Lypemania,  326,  416. 


M. 


Magnan,  on  the  production  of  hallu- 
cinations in  dogs,  261. 

Mahomet,  the  visions  of  446. 

Mandeville,  on  instinctive  acts,  259. 

Mania,  326  ;  gouty,  1 97  ;  intermittent, 
200  ;  rheumatic,  201  ;  post-febrile, 
204  ;  sympathetic,  208  ;  transitoria, 
229,  274,  413.  501  ;  epileptic,  340 
444 — 449  ;  moral,  352  ;  sine  delirio, 
355 ;  hysterical,  461  ;  symptoma- 
tology of  acute,  395 — 415  ;  precur- 
sory symptoms  of,  395,  396 ;  hallu- 
cinations in,  399  ;  different  types  of, 
405  ;  acute  delirious,  405,  406,  505  ; 
state  of  memory  in,  407  ;  the  tempe- 
rature in,  408  ;  course  of,  411 — 415  ; 
periodic  or  recurrent,  412  ;  chronic, 
415  ;  of  pubescence,  450  ;  puerperal, 
467 ;  senile,  476  ;  phthisical,  478, 
p  479  ;  morbid  changes  in  acute,  505  ; 
i  mori)id  changes  in  chronic,  506 ;  a 
potu,  484  ;  sleep  in,  562. 
Marriage,  unwise  recommendation  of, 

457,  463. 
Materialism,  496. 

Melancholia,  326  ;  symptomatology  of, 
356—395  ;  uterine,  208,  497  ;  alter- 
nation of,  with  mania,  352,  394,  412; 
antecedent  symptoms  of,  356,  357  ; 
simple,  358  ;  panic  in,  365,  392  ;  in- 


termissions of,  366,  393  ;  attonita, 
357,  380  ;  hypochrondriacal,  370, 
471  ;  hallucinations  in,  371 — 377  ; 
acute  or  agitans,  382  ;  suicide  in,  384 
—389  ;  homicide  in,  389—393;  the 
course  of,  393 — 395  ;  of  pubescence, 
451  ;  puerperal,  468  ;  climacteric, 
470  ;  senile,  476  ;  a  potu,  484  ;  sym- 
pathetic, 497  ;  the  morbid  chai)ges 
in  acute,  506  ;  sleep  in,  662,  563. 
Menstruation,  irregularities  of,  197,210; 
in  melancholia,  378  ;  in  mania,  409  ; 
insanity  caused  by,  465  ;  treatment 
of,  564,  565. 
Meschede,  Dr. ,  on  the  morbid  changes 

in  general  paralysis,  517. 
Metastasis,  201,  218. 
Meyer,  Dr.  Ludwig,  on  mania  transi- 
toria, 274. 
Mickle,  Dr.  J.,  on  varieties  of  general 

paralysis,  508. 
Mierzejewski,  Dr.,  on  idiocy,  515. 
Mill,  J.  S.,  on  individuality,  298. 
Milton,  282. 

Monomania,    217,      326  ;    symptoma- 
tology of,    415 — 425  ;    predisposing 
causes  of,  419  ;  the  course  of,  420  ; 
general  mental  impairment  in,  421 — • 
424  ;  epileptic,  445  ;  phthisical,  479. 
Monomanie,    affective,    355,    416  ;    in- 
stinctive, 416  ;  intellectuelle,  416. 
Moreau,  a  case  of  moral  insanity,  287; 
on  the  physical  condition  of  genius, 
301. 
Morphia,  the  hypodermic  injection  of, 

556. 
Morrison,  Sir  A.,  on  insanity  in  chil- 
dren, 259,  260. 


N. 


Kature,  the  laws  of,  135,  153  ;  the 
sympathetic  study  of,  141 ;  the  creed 
of,  142. 

Nerve-cells,  cerebral,  morbid  changes 
in,  516 — 518  ;  pigmentary  degene- 
ration of,  517  ;  calcification  of,  518. 

Nervous  centres,  different  constitution 
of,  195. 

Nervous  exhaustion,  490. 

Nervous  system,  the  mimicry  by,  68. 

Nervous  structure,  hidden  defects  of, 
183,  185,  490 ;  materialisation  of 
function  in,  185,  489. 

Nervous  diseases,  predisposing  to  in- 
sanity,   107,    108  ;  hybrid   varieties 


INDEX. 


577 


of,  107  ;  functional  and  organic, 
109,  110 ;  the  transformation  of, 
218,  229,  230. 

Neuralgia,  107  ;  reflex,  206  ;  forebod- 
ing general  paralysis,  438. 

Neuritis,  syphilitic,  481. 

Neuroglia,  the  increase  of,  511. 

Neurosis,  spasmodica,  58,  18(j,  297  ; 
the  criminal,  103 ;  the  epilei»tic, 
103,  337  ;  the  insane,  103,  186,  297, 
337  ;  transformation  of,  107,  108  ; 
the  outcomes  of,  113. 

Nicolai,  his  hallucinations,  375. 

Nightmare,  the,  29,  32 ;  in  children, 
48,  263  ;  a  waking,  380. 

Nutrition,  states  of  deteriorated,  171  ; 
depression  of,  in  melancholia,  378  ; 
state  of,  in  general  paralysis,  438. 


O. 


Observation,  insufficient,  6Q,  67  ;  in- 
iluence  of  faith  on,  79,  80. 

Odic  force.  Baron  Eeichenbach's,  53. 

Old  age,  the  dreams  of,  46,  47  ;  the 
decay  of,  120,  168,  475. 

Opium,  the  sleep  of,  5  ;  relief  pro- 
duced by,  220 ;  in  the  treatment  of 
insanity,  5.^)4 — 556. 

Optimism,  386. 

Organism,  the,  the  sleep — needs  of,  1, 
2  ;  the  physiological  unity  of,  11,  12, 
369,  566  ;  relation  to  environment, 
85  ;  the  social,  99,  160  ;  the  tyranny 
of,  349  ;  dependence  of  moral  feeling 
on,  354. 

Organic  impressions,  29 — 35. 

Originality,  299,  300. 

Othsematoma,  384, 

Over-population,  171. 

Oxaluria,  symptoms  of,  199. 


P. 


Pachtmentngitis,  in  general  paralysis, 

507  ;  acute,  508. 
Pack,  the  wet,  541 — 545. 
Pain,  varieties  of,  403. 
Palate,  the  saddle-shaped,  179. 
Panic,  melancholic,  365,  392. 
Panphobia,  238,  361. 
Paralysis,    general,    225,    432  —  434  ; 

syphilitic,  481  ;  alcoholic,  486. 
Passions,    the,    159 ;    the   depressing, 

222  ;  the  elated,  224,   419  ;  the  best 

sort  of,  244. 


Pauperism  and  insanity,  133. 

Pellagrous  insanity,  199. 

Perception,  acute,  68,  69 ;  education 
of,  in  infant,  257  ;  compound  nature 
of,  376  ;  by  somnambulists,  62. 

Persecution,  some  effects  of,  136,  137  ; 
delusions  of,  374,  389,  394. 

Personal  identity,  in  dreaming,  11,  12. 

Pessimism,  386. 

Philanthropist,  the  selfishness  of,  242, 
243. 

Phosphates,  increase  of,  in  urine,  490. 

Phosphuria,  199. 

Phthisis,  as  cause  of  insanity,  112, 
213  ;  and  insanity,  479,  520. 

Pick,  Dr.  A.,  on  a  peculiar  state  of 
consciousness,  28. 

Pinel,  on  mania  sine  delirio,  355  ;  on 
the  primary  seat  of  mania,  399  ;  on 
morbid  changes  in  insanity,  490  ; 
his  reform  in  the  treatment  of  in- 
sanity, 523. 

Plants,  the  cross-fertilisation  of,  122. 

Pneumonia,  519. 

Poe,  Edgar  Allan,  301. 

Poisons,  the  specific  effects  of,  195, 
200. 

Potassium,  bromide  of,  its  use  in  eyii- 
lepsy,  448  ;  its  use  in  insanity,  558, 
560,  .561. 

Poverty,  the  fear  of,  385. 

Prayer,  the  effects  of,  138. 

Predestination,  origin  of  doctrine  of, 
91. 

Pregnancy,  the  mental  effects  of,  209  ; 
insanity  of,   209,  467. 

Pri chard,  Dr.,  a  case  of  moral  insanity, 
285 ;  on  moral  insanity,  346. 

Priesthood,  a,  useful  functions  of,  14S, 
149. 

Prognosis,  the,  in  melancholia,  393 ; 
in  mania,  412  ;  in  monomania,  420  ; 
in  general  paralysis,  442  ;  in  epileptic 
insanity,  448  ;  in  insanity  of  self- 
abuse,  460  ;  in  hysterical  insanity, 
465  ;  in  puerperal  insanitj',  468  ; 
in  climacteric  insanity,  470 ;  in 
phthisical  insanity,  479  ;  in  syphilitic 
insanity,  564. 

Progress,  the  foundation  of,   137. 

Pubescence,  the  insanity  of,  449 — 452. 

Pulse,  the  differences  of,  in  different 
arteries,  190  ;  in  melancholia,  193, 
378  ;  in  primary  disease  of  brain, 
193. 

Punishment,  natural,  135,  153  ;  eter- 
nal, 141. 


578 


INDEX. 


Pupils,  the  inequality  of,   436. 
Purgation,  the   abuse  of,  in    insanity, 

549. 
Pursuits,   effects   of,    upon    character, 

134,  135. 
Pyromania,  344, 


Q. 


QuiNCY,  De,  301. 


R. 


Kacehorses,  barrenness  of  mares,  121. 

Reason,  contradictions  of,  139. 

Recovery,  signs  of,  in  melancholia,  393; 
period  of,  394  ;  in  mania,  412,  413; 
in  monomania,  420  ;  in  general  par- 
alysis, 442. 

Reflex  action,  morbid,  205 — 218,  497, 
498. 

Reichenbach,  Baron,  on  odic  force,  53; 
on  perception  by  somnambulists,  62 
—  64  ;  his  sensitives,  319. 

Relapse,  the  threatenings  of,  414. 

Religion,  influence  of,  on  the  causation 
of  insanity,  135—152  ;  the  Chris- 
tian, 146  ;  the  Roman  Catholic,  148; 
the  true  function  and  actual  effect 
of,  151. 

Responsibility,  in  mental  disease,  246 
—248. 

Restraint,  chemical  and  mechanical, 
553. 

Retina,  the,  colloid  degeneration  of, 
515 ;  pigmentary  degeneration  of, 
517. 

Reversions,  to  ancestral  experiences, 
27,  34  ;  to  animal  instincts,  116. 

Reymond,  Du  Bois,  on  electrical  cur- 
rents in  nerves,  494. 

Rheumatism,  the  occurrence  of,  120  ; 
a  cause  of  insanity,  201. 

Riches,  the  love  of,  161,  168. 

Richter,  Jean  Paul,  26. 

Rindfleisch,  Dr.  E.,  on  the  morbid 
changes  in  tabes  dorsalis,  512. 

Ritualists,  confession  among,  144. 

Robertson,  Dr.  Lockart,  on  packing  in 
the  wet  sheet,  545. 

Robin,  on  the  secondary  sheaths  of 
small  arteries,  512. 

Rokitansky,  on  diffuse  pachymeningitis, 
507  ;  on  diseased  capillaries  in  gene- 
ral pai-alysis,  511  ;  on  the  increase 
of   the   neuroglia,    512,     514  ;    case 


of   induration    of   the    creliac  axis, 
421. 
Rome,  the  Church  of,  persecution  by, 
136  ;  confession  in,  144. 


S. 


Saints,  the  communion  of,  157. 

Sander,  Dr.  Julius,  on  absence  of  the 
corpus  callosum,  178. 

Sankey,  Dr.,  on  the  morbid  changes  in 
general  paralysis,  507. 

Savage,  Dr.,  on  hyoscj'amine,  559  ;  on 
conium  in  the  treatment  of  in- 
sanity, 560  ;  on  hellebore  in  amen- 
orrhoea,  565. 

Savages,  insanity  among,  127 — 131  ; 
239  ;  the  senses  in,  130  ;  the  moral 
sense  in,  129,  130  ;  the  conservatism 
of,  129. 

Schamans,  the  Siberian,  446. 

Schlager,  Professor,  on  injxiries  of  the 
head,  226. 

Schwarzenthal,  Dr.  A,,  a  case  of  ab- 
scess of  the  brain,  235. 

Sclerosis,  the  morbid  changes  of,  513. 

Scrofula,  as  cause  of  insanity.  111. 

Seances,  spiritualistic,  63. 

Secretion,  derangement  of,  in  melan- 
cholia, 378  ;  in  mania,  403. 

Sects,  evil  effects  of,  149. 

Sedatives,  the  use  of  and  abuse  of,  in 
insanity,  550 — 558,  562. 

Self-abuse,  eff"ects  of,  225,  338;  in- 
sanity of,  225,  276,  280,  452— 463._ 

Self-control,  in  melancholia,  367  :  in 
mania,  398,  400  ;  morbid  impairment 
of,  391  ;  in  monomania,  417,  418. 

Self-consciousness,  in  acute  mania,  404. 

Self-feeling,  exaggei'ated  development 
of,  240—245  ;  the  good  side  of,  244  ; 
intense  family,  306  ;  exaltation  of, 
395,  402,  439. 

Self-knowledge,  a  means  of,  119. 

Self-love,  wounds  of,  222. 

Self-i'enunciation,  the  lessen  of,  160, 
163. 

Self-sacrifice,  a  good  work  of,  540. 

Self-torture,  311—317. 

Senility,  475. 

Senses,  the  degrees  of  sleep  of,  5  ;  im- 
pressions on,  in  sleep,  20—30,  58  ; 
conditions  of,  in  hypnotism,  52,  58  ; 
in  somnambulism,  60-62  ;  in  savages, 
130  ;  the  vital,  215. 

Sensibility — muscular,  35 — 39  ;  anom> 


INDEX. 


579 


alies  of,  216  ;  in  melancholia,  367 — 
377  ;  disorders  of  organic,  369  ;  loss 
of,  in  dementia,  427 ;  loss  of,  in 
dementia,  427  ;  loss  of,  in  general 
paralysis,  437. 

Sensitives,  Rcichenbach's  so-called,  53, 
63,  64,  319. 

Sex,  in  heredity,  117,  118  ;  in  insanity, 
164—167. 

Sexual  excesses,  effects  of,  225,  338  ;  as 
cause  of  general  paralysis,  433,  434. 

Shakspeare,  80,  84,  141,  301. 

Shakers,  the,  144,  157. 

Shock,  fatal  effects  of  moral,  490. 

Shuttleworth,  Dr.,  on  the  brain  of  an 
imbecile,  176. 

Siamese  twins,  the,  mental  sympathies 
of,  70  ;  the  quarrels  of,  87. 

Si;jht,  hallucinations  of,  376. 

Sin,  the  unpardonable,  358,  360. 

Single  patients,  533. 

Skae,  Dr.  D.,  the  insanity  of  preg- 
nancy, 209  ;  ovarian  insanity,  211  ; 
insanity  from  injur}-  to  the  head, 
227  ;  homicidal  insanity,  334,  340  ; 
sexual,  430 ;  a  clinical  classification 
of  insanity,  432  ;  general  paralysis, 
435,  440  ;  amenorrhceal  insanity,  465. 

Skae,  Dr.  Holland,  a  case  of  insanity 
from  injury  to  the  head,  227. 

Skin,  the  loss  of  sensibility  of,  215  ; 
in  the  insanity  of  children,  264,  271, 
287  ;  in  melancholia,  368  ;  in  mania, 
409. 

Skull,  the,  premature  ossification  of, 
178  ;  a  successful  trephining  of,  227, 
448,  547. 

Sleep,  1  —  49  ;  purpose  of,  1  ;  causes 
and  conditions  of,  2—5  ;  effects  of  de- 
privation of,  2  ;  condition  of  brain 
during,  3  ;  A'arj-ing  states  of,  4,  5  ; 
narcotic,  5  ;  effects  of  expectation 
and  habit  on,  6,  7  ;  whether  ever 
dreamless,  7,  8  ;  methods  of  pro- 
curing, 40,  563  ;  talking  in,  48  ;  the 
hypnotic,  50 — 60  ;  induction  and 
phenomena  of  so-called  mesmeric, 
51,  52  :  in  melancholia,  378,  379, 
562  ;  in  mania,  410,  562. 

Smell,  hallucinations  of,  376,  377. 

Somnambulism,  60 — 68  :  state  of  senses 
in,  60 — 62  ;  state  of  memory  in,  61; 
skilful  feats  in,  61  ;  the  muscular 
sense  in,  62  ;  the  miraculous  percep- 
tions in,  63  ;  its  kinship  to  epilepsy, 
76,  82  ;  homicide  during,  81. 

Soul,  delusion  of  lost,  361. 


Spermutorrhcea,  mental  effects  of,  338. 

Spinoza,  140. 

Spiritualism,  77 — 80  ;  repoi't  on,  80. 

Square,  a,  inability  to  cross,  319. 

Starvation,  the  delirium  of,  198. 

Statistics,  of  a  predisposition  to  in- 
sanity, 106,  107  ;  function  of,  109  : 
of  insanity,  131. 

Stigmata,  71,  324,  461. 

Stigmatic,  the  Belgian,  71. 

Stimulants,  the  use  of,  in  insanity,  518. 

Strychnia,  200,  500  ;  the  excretion  of, 
552. 

Suicide,  107,  108  ;  in  children,  279  ; 
in  insanity,  332,  366 ;  in  melan- 
cholia, 384 — 389  ;  arguments  against, 
387  :  reason  of,  3^7  ;  hereditary, 
389 ;  in  hypochondriacal  melan- 
cholia, 472. 

Supernatural,  the,  belief  in,  137 — 142. 

Superstition,  a  scientific,  154. 

Suspicion,  morbid,  101,  242,  307  ;  de- 
lusions of,  390. 

Sympathy,  mental,  69,  70,  155  ;  with 
nature,  141  ;  the  inflection  of,  157  ; 
pathological,  205 — 218  ;  physiologi- 
cal, 111,  112,  566  ;  morbid  family, 
306. 

Syncope,  the  eflfect  of  moral  shock, 
490  ;  caused  by  chloral  hydrate,  557. 

Synergy,  155. 

Synthesis,   155. 

Svphilis,  effects  of,  200  ;  and  insanity, 
"480,  564. 

Syphiloma,  509. 

Swedenborg,  insanity  of,  417  ;  pro- 
bable epilepsy  of,  446. 


Tacf.s  dorsalis,  435,  512. 

Tartar  emetic,  in  the  treatment  of  in- 
sanity, 561,  562. 

Taste,  halucinations  of,  376. 

Temperament,  an  unstable,  56,  65,  SO, 
186,  297 — 325  ;  influence  of,  on  be- 
lief, 65,  80  ;  influence  of,  on  obser- 
vation, 67  ;  the  phthisical,  112,  478, 
479  ;  a  cause  of  emotional  anxiet}'", 
170  ;  the  action  of  alcohol  on,  195  ; 
the  sensitive,  213  ;  need  of  study  of, 
236  ;  tubercular,  267  ;  varieties  of  an 
insane,  305 — 321  ;  the  egoistic,  305; 
the  suspicious,  307 ;  the  self-to^-- 
menting,  311;  the  impulsive,  312; 
the   miserly,   317  ;  the  morally  de- 


5S0 


INDEX. 


fective,  318  ;  bodily  features  of    an 

insane,   320,    321  ;   the  melancholy, 

385,  386. 
Temperature,  the,  in  mania,    408  ;  in 

general  paralysis,  442,  443. 
Tendencies,  the  fostering  of  bad,  1G2. 
Tennyson,  Alfred,  26. 
Theoieptics,  71. 
Theresa,  St.,  71,72,  144. 
Thurnam,  Dr.,  on  the  relative  liability 

of  men  and  Avomento  insanity,  166  ; 

on  the  prognosis  in,  535. 
Time,  in  nervous  and  mental  functions, 

492—494. 
Tissues,  the,  intrinsic  action  of,  498, 

500. 
Tone,   the  mental,  202,  211,  220,   277, 

330. 
Torture,  insensibility  to,  72. 
Trance,  70. 
Travelling,    the    recommendation    of, 

534,  535. 
Treatment,  the,  of  insanity,  522 — 566  ; 

the  importance  of  early,  531,  534, 

535;  in  private  houses,  533. 
Trephine,  the,  successful  use  of,  in  in- 
sanity, 227;  and  in  epilepsy,  448,  547. 
Trousseau,    on    morbid  impulses  after 

epilepsy,  341, 
Tubercle,  meningeal,  267;  in  the  insane, 

5. 
Tuke,  Mr.  Samuel,  on  the  effects  of  fever 

upon  mental  derangement,  191. 
Tuke,  Dr.,  J.  B.,  on  puerperal  insanity, 

210. 
Tumour,  of  brain,  230,  231  ;  diagnosis 

of,  233. 
Twins,  mental  sympathies  of,  70  ;  dif- 
ferent dispositions  of,  87  ;  insanity  in, 

310. 


U. 


UNrjERSTANDiXG,  an  insincerity  of, 
138,  139,  145,  147  ;  arrest  of  deve- 
lopment, of,  149. 

Urine,  the,  in  melancholia,  378  ;  and  in 
mania,  410. 

Uterus,  mental  effects  of  disease  of, 
208,  497. 


V. 

Vacillation,  morbid,  311. 


Varieties,  degenerate  or  morbid,  292, 

293. 
Vclpeau,    surgical   operations    by,    on 

hypnotics,  52. 
Vertigo,  nature  of,  36  ;  in  crossing  a 

S(i[uare,  319. 
Vircnow,  on  diffuse   pachymeningitis, 

507  ;  on  syphiloma,  509. 
Volition,  time-rate  of,    493  ;  slowness 

of,  494. 
Voltaire,  on  the  effects  of  magic  words, 

67. 


W. 


Waking,  causes  of,  1,  2 ;  successive 
phases  of,  5. 

Wanderings,  of  persons  with  delusions 
of  persecution,  374. 

Wassilief,  on  morbid  changes  in  hy- 
drophobia, 514. 

"Weber,  Dr.  H. ,  on  the  temperature  in 
post-febrile  mania,  408. 

Wedl,  on  diseased  capillaries  in  gene- 
ral paralysis,  511  ;  on  morbid  changes 
in  idiocy,  514. 

West,  Dr.,  case  of  insanity  in  a  child, 
273. 

Westphal,  Prof.,  on  the  increase  of  con- 
nective tissue  in  general  paralysis, 
507. 

Whytt,  Dr.  Robert,  on  pathological 
sympathy,  206  j  case  of  insanity  in 
a  boy,  264. 

Wild  men,  178. 

Will,  the,  during  dreaming,  10  ;  the 
strengthening  of,  138,  163  ;the  free- 
dom of,  156,  187  ;  enervation  of,  324; 
degrees  of,  325. 

Wilks,  Dr.,  on  calcified  nerve  cells, 
518. 

Willis,  Dr.,  on  the  elation  of  mania, 
397. 

Women,  the  education  of,  163  ;  the 
predominance  of  the  aflective  life  in, 
163,  450  ;  the  rareness  of  general 
paralysis  in,  434  ;  the  change  of  life 
in,  168,  469. 

Woorara  poison,  the,  200. 

Worms,  intestinal,  a  cause  of  insanity 
in  children,  276. 


WORKS  OF  HENRY  MAUDSLEY,  M.  D, 

Fellow  of  the  Royal  College  of  Physicians;  Professor  of  Medical  Jurisprudence  in  Uni 

vcrsity  College,  London. 


Body  and  Mind : 

An  Inquiry  into  their  Connection  and  Mutual  Influence,  specially  in  refer- 
ence to  Mental  Disorders,     1  vol.,  12mo.     Cloth,  81.50. 

Physiology  of  the  Mind. 

Xew  edition.  1  vol.,  12mo.  Cloth,  $2.00.  Contents:  Chapter  I.  On  the 
Method  of  the  Study  of  the  Mind. — II.  The  Mind  and  the  Xervous  System. 
— III.  The  Spinal  Cord,  or  Tertiary  Xervous  Centres ;  or,  X'ervous  Centres 
of  Reflex  Action. — IV.  Secondary  Nervous  Centres ;  or  Sensory  Ganglia ; 
Sensorium  Commune. — Y.  Hemispherical  Ganglia ;  Cortical  Cells  of  the 
Cerebral  Hemispheres  ;  Ideational  Xervous  Centres ;  Primary  Xervous  Cen- 
tres ;  Intellectorium  Commune. — VI.  The  Emotions. — VII.  Volition. — 
VIII.  Motor  Nervous  Centres,  or  Motorium  Commune  and  Actuation  or 
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THE  PHYSIOLOGY  OE  MAI; 


DESIGNED  TO  RBPEESENT 


The  Existing  State  of  Physiological  Science,  as  applied  to  the 
Functions  of  the  Human  Body. 

By    AUSTIN     FLINT,     Jr.,    M.D., 

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HEALTH  PRIMERS. 

EDITED   BY 

J.    LANGDON   DOWN,  M.  D.,    F.  R.  C.  P. 
HENRY   POWER,  M.  B.,  F.  R.  C.  S. 
J.   MORTIMER-GRANVILLE,    M.  D. 
JOHN   TWEEDY,    F.  R.  C.  S. 

THOUGH  it  is  of  the  greatest  importance  that  books  upon  health  should  be  in 
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popular  kind  are  mere  crude  compilations  of  incompetent  persons,  and  are  often 
misleading  and  injurious.  Impressed  by  these  considerations,  several  eminent 
medical  and  scientific  men  of  London  have  combined  to  prepare  a  series  of  Health 
Primers  of  a  character  that  shall  be  entitled  to  the  fullest  confidence.  They  are 
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VOLUMES   OF  THE   SERIES. 

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The  Head. 

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Water. 

The  Skin  and  its  Trouhles. 

Fatig-ue  and  Pain. 

The  Ear  and  Hearing. 

The  Eye  and  Tision. 

Temperature     in     Health     and 


Exercise  and  Training.    (Illus- 
trated.) 

Alcohol :  Its  Use  and  Ahuse. 

The   House   and    its    Surround- 
ings. 

Premature    Death:    Its   Promo- 
tion or  Prevention. 

Personal  Appearances  in  Health 
and  Disease.    (Illustrated,) 

Baths  and  Bathing". 


Disease. 

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HEALTH, 


AND 


HOW      TO      PROMOTE      IT. 


By  RICHARD    McSHERRY,  M.  D., 

Professor  of  Principles  and  Practice  of  Medicine,  University  of  Maryland ;  Member  of 
American  Medical  Association  ;  President  of  Baltimore  Academy  of  Med  cine. 


Extract  from  Preface. 

"  Hygiene,  public  and  private,  has  become,  of  late  years,  one  of  the  most  im- 
portant elements  of  modem  civilization.  It  is  a  subject  in  which  all  mankind  has 
an  interest,  even  if  it  be,  as  it  too  often  is,  an  unconscious  interest. 

"  The  present  work  is  addressed  to  the  general  reader,  no  matter  what  his  pur- 
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intelligent  patient ;  it  is  therefore  as  free  as  such  a  work  can  be  made  from  scien- 
tific technicalities. 

"  It  is  offered  as  a  contribution  to  a  great  cause,  and  the  writer  trusts  that  it 
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to  a  great  extent,  put  in  practice  in  the  personal  experience  of  the  writer  in 
various  parts  of  the  world,  and  under  many  vicissitudes,  and  he  has  found  them 
to  be  not  vague  theories,  but  practical  truths  of  the  greatest  importance." 


C  O  ISr  T  E  3>TT  S  . 
PART  L— INTRODUCTORY  REMARKS. 
Hygiene  the  Better  Part  of  Medicine.— The  Four  Divisions  of  Human  Life:   The  First 
Quarter,  or  the  First  Score  of  Years.     The  Young  Man ;   the  Young  Woman.    The 
Man ;  the  Woman.    The  Declining  or  Old  Man. 

PART  IT.—EYGIEmCS  IN  SOME  DETAIL. 

Eace,  Temperaments,  and  Idiosyncrasies.— Inheritance. — Habit. — Constitution. — The  Air 
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of  Naval  Surgeons. 


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IL— SOUND : 

A  Series  of  Simple,  Entertaining,  and  Inexpensive  Experiments  in  the  Phenomena 
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By  ALFRED  MARSHALL  MA  YER, 

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Society. 

In  Active  Preparation: 

III.  Vision  and  the  Nature  of  Light. 

IV.  Electricity  and  Magnetism. 
V.  Heat. 

VI.  Mechanics. 
VII.  Chemistry. 

VIII.  The  Art  of  experimenting  ivith  Cheap  and  Simple   In- 
struments. 


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